Hello, this is Dr Grande Today.’s, question is what is Illness Anxiety Disorder If you find this video to be interesting or helpful, please like it and subscribe to my channel That way, you won’t miss any new videos. Now, when we talk about illness, anxiety disorder, we talk about a mental disorder where an individual is preoccupied with concern about having a serious illness, and this is an interesting disorder because it’s fairly, similar to Obsessive Compulsive Disorder. And there’s even a debate. In a mental health community About whether or not Illness, Anxiety disorder is really just a variant of OCD. So when we look at the criteria for Illness, Anxiety Disorder, there’s, another interesting feature. A lot of mental disorders in the DSM have a symptom criteria section and Then other criteria. So there may be Nine symptoms in the symptom criteria section and somebody might have to meet four or five of those symptoms to qualify For that criterion. And then there are other criteria that have to qualify for as well With illness, anxiety disorder. All of the different criteria are required. There is no section in the DSM with illness, anxiety disorder That has a number of symptoms where somebody only has to meet a certain Number less than that for the diagnosis. For example, if we consider Borderline Personality Disorder, that disorder has nine symptoms in the symptom criteria, But an individual only needs to have five of those to qualify for that diagnosis. So again with Illness, Anxiety, Disorder, all the symptoms are required. So the first symptom is a preoccupation with having or acquiring a serious illness. Now the DSM doesn’t specifically say that this would be a mental disorder or a medical disorder, but most of the time we interpret this as relating to a possible medical disorder, a concern over having or getting a medical disorder, because we usually conceptualize this first Criterion as being related to medical disorders, this brings up an important point in terms of the distinction between a talk therapist and a physician. For example, I have a PhD in counselor education and supervision and I’m a licensed counselor. I’m, not a physician and most talk. Therapists are not physicians either. So with this particular diagnosis of illness, anxiety disorder. As a talk therapist, you would be working with somebody who has complaints or concerns about a medical disorder. So it’s important to make the referral to a physician so that you know if they in fact have the disorder or don’t That’s an important element in terms of the mental health treatment to know if that medical disorder is really there Or not Now, of course, a lot of times when we treat individuals with Illness, Anxiety Disorder, they have been referred by a physician and we already have the information that shows that they did not qualify for a diagnosis of any type of medical disorder, at least not The medical disorder that they’re worried about. The second criterion is that there are little or no somatic symptoms, So there’s another disorder, which is difficult to differentiate from Illness, Anxiety, Disorder, called Somatic Symptom Disorder, and I have another video that discusses these two disorders. Together With Illness, Anxiety Disorder, there can be mild somatic symptoms, but that’s really not the emphasis as the symptom criterion suggests. The anxiety is not coming primarily from physical, sensations of the person’s having, but rather the meaning or significance of having the illness. That they’re worried about having The third symptom criterion is the individual is experiencing a high level anxiety about health related concerns? The fourth is that there’s excessive health related behavior, like checking or maladaptive avoidance, so a lot of times we think of this disorder and compare it to OCD. It’s, this particular symptom criterion. That makes it difficult to distinguish the two, because that health related behavior, as I mentioned oftentimes, involves checking and, of course, OCD oftentimes involves checking The fifth symptom criteria is that the disturbance has been present for six months, but the illness that the person is worried about. Can change in that time So a lot of times we think of Illness, Anxiety Disorder, we think of one particular illness that the person is worried about having or acquiring, But sometimes with this disorder. If they have evidence that shows that they don’t have a particular medical disorder, they were worried about. Then they might develop a fear about another potential medical disorder, So the illness can change, but the disturbance would be present for at least six months, and The sixth symptom criterion is that this disturbance is not better explained by another mental disorder and there’s a Number of mental disorders listed in the DSM as examples. One of them is OCD Again, emphasizing this difficult differentiation between illness, anxiety disorder and OCD. It’s important to note here as well that somebody can have Obsessive Compulsive Disorder and Illness Anxiety Disorder. At the same time, These can be comorbid and oftentimes. They are comorbid This six symptom criterion that not better explained by another mental disorder criterion. Doesn’t mean that the two can’t co occur. It just means that if you’re looking at a presentation that you think is Illness, Anxiety, Disorder and the symptoms are in fact better explained by OCD, then you would consider OCD over illness anxiety disorder. This can certainly become confusing, but the term not better explained doesn’t mean that the two are mutually exclusive, that the two disorders cannot co occur. Now it’s also important to note that, with illness anxiety disorder, There are two subtypes. These are not specifiers, but rather subtypes, So an individual would have to have one, and only one of these subtypes There’s the care seeking type and the care avoiding type. So an individual with Illness. Anxiety Disorder would have to be categorized as one of these two types they could not be assigned both types. Some other interesting associated characteristics with Illness. Anxiety Disorder include that there’s, usually not a desire for perfectionism. With this disorder like we would see with OCD and also in terms of what medical disorder or serious illness somebody’s worried about it:’s, oftentimes, not a communicable illness, so the concern would more likely be over a medical disorder like cancer or heart disease. As opposed to influenza, Now in terms of the treatment for Illness, Anxiety Disorder, we don’t have a lot of research on the treatment effectiveness for illness, anxiety disorder specifically, but generally, we believe that mental health talk therapy is somewhat effective in relieving the symptoms of Illness, Anxiety Disorder. I hope you found this description of Illness Anxiety Disorder to be interesting Thanks for watching
Hey, welcome to this video. My name is Tom, from the Alive Academy.com. And in this video we will make visible what
the real root or cause of an panic disorder also known as APA. Only when we know the real cause, we can heal
the root and there for automatically liberate ourselves from every other anxiety-disorder-symptom
too, such as a fast heart, trembling, shaking, confusion, dizziness, nausea and or difficult
breathing. Only if we know what the real root of the
problem is, we will know how we can stop our panic disorder completely and for once and
for all. A panic disorder is a mental disorder characterized
by feeling anxiety and fear. To end the root of the problem together with
all it symptoms for once and for all, and there for to shine the light onto our ‘dark’
panic disorder or fears, I came up with a drawing to show you. I don't want to give you a superficial solution,
so I want to take you back to the origin. To the moment we were born. Let's represent this heart as a symbol of
our free pure and fulfilled feeling at our birth.
Then from that moment until now, we have all
encountered painful emotions and none of us have learned how to solve this pain. This pain sets around our pure and fulfilled
feelings. Of course no one of us really want to feel
this pain, that is why we all found a different way of dealing with this. You know how? By building a wall of control around it.
And how do we build that wall? We all know this I guess. From that moment we stop living from our feeling
and start living from our mind or our thinking. Let me symbolize this brain for our thinking. From that moment we use our thinking nonstop
to search for distractions outside ourselves, that will have to prevent us from feeling
pain. And these distractions or our non stop thinking,
yes of course I should be doing this, or I should be doing that, or otherwise it wouldn't
feel right, this, this and that. This annoying little voice inside our head,
I am sure we all know off, serves us as a band aid, on top of our wall of control. To prevent ourselves from feeling. The problem is that we do not just cover up
just our pain, but also our pure feelings. And within our distractions we are still looking
for a feeling. For example in creating success, we are actually
looking for a feeling of fulfillment.
Or by starting a relationship, because we'd
rather not be alone, because then we are not distracted anymore and then we feel pain. So we are searching for a feeling to fulfill
ourselves with a relationship. And even in simple things a new Smartphone,
a new car, new house, we search for this long lasting feeling of being complete and fulfilled
by running away from our feelings. The contradiction shows itself very clearly,
yet we do not question ourselves about these choices and the routine that is has become
for so many of us.
We rather invest all of our money in time
to build a life filled with these distractions that never work permanently. That create something like a reality replacement
for the feeling that we actually are missing. A replaced identity of ourselves. And we start to believe to have become this
illusion. The problem is that when we are running away
from our feelings and at the same time are looking for in these distractions for a feeling
of fulfillment that never comes, then we will have to continuously search for new distractions. New, new etc. Until we can't keep up anymore. This pattern is extremely exhausting, we all
are aware of this, let me symbolize sweat drops for this. This is an imprisoning pattern. Let me symbolize a lock for this. Now what is fear? Fear is just the resistance that we would
fail in getting our next distraction or that one of our created distractions will disappear
or will be taken away from us. Because then our band aid will no longer work
and then obviously we will start to feel the pain again that we haven't resolved yet.
I hope by showing you this drawing that fear
has a very valuable function. That fear is not only pretty annoying, but
it is also a wake – up call. That this replacement reality doesn’t work. So as long as we still experience fear, tells
us that we are still having unsolved pain and are settling for a replacement reality
instead of independently feeling fulfilled and alive in freedom. There actually is a reality possible in which
we can choose to live the way we really are, feeling independently fulfilled. Without fear and unsolved pain. If we learn to solve all of our unsolved pain
and fear, our restlessness thinking to escape in distractions isn't necessary anymore either
and only then we can start to create in freedom.
Only then we can start a relation in freedom
or success or whatever we feel like creating. And only then we don't have any fears that
it will disappear again. And only then we can truly enjoy to the fullest
and we don't have any fears anymore, that things people or achievements may be taken
away from us. Because we feel complete and fulfilled independently
without experiencing fear and having pain anymore. Do you know the difference between creating
something as a distraction or as an addiction or as a compensation, because this is the
mask we all are wearing, the mask of pretending.
The difference between this and doing something
out of free will, an easy way to check is to stop doing what you are doing, and you
are still feeling completely fulfilled then you are acting out of free will. On the other hand, when you stop doing what
you are trying to do or achieve and you will start feeling restless, because that is how
pain feels. Pain doesn’t feel like; ahhh I'm in pain,
pain feels like feeling restless, irritated, angry, bored. Then you know you are doing it to create a
compensation reality or as a distraction from unsolved feelings. And the good news is that there actually is
a way to solve the root of all pain, which will make all fear to feel pain vanish as
well. Which will let you create without limitations,
and importantly you don't need to go through this pain again to get rid of it. We know now that all of our fears and other
symptoms are helping alarm signals and serve us with a very valuable message. Our fear and symptoms are here to tell us
that the direction that we are going, is a wrong and unhealthy direction.
It warns us that if we continue to ignore
this wrong, unhealthy direction, of dis-ease, that our body might come up with bigger actual
diseases. Our fear and our symptoms are here to tell
us that liberation and cure is to be found in the opposite direction: in solving our
unsolved pain, so no more fears or symptoms can arise. Do you believe by numbing these alarm signals,
f.e. by taking medication, will help us to solve the real problem? Or does it give us another short shot of distraction,
like we’ve seen in the drawing? The more I was trying to create a successful
mask, or the more I was trying to run away from my insecurity or fears, the more my exhausting
and limiting fears kept arising in other forms and didn’t go away. I only started to feel truly liberated, relaxed,
filled with joy, filled with self esteem and enjoying everything around me, when I decided
to get to the root of my fear and pain and solved them. When we are no longer imprisoned in this exhausting
system by fears, pain and relating symptoms, we will feel independently filled with joy.
When we feel only joy without fear, there
won’t be any obstructions left, to create whatever belongs to us naturally. When we create out of joy, without any obstructions,
success and abundance are just a logical consequence. Basically liberating ourselves from this limiting
imprisonment by fear and pain, is the key to go from limitations and scarcity, to true
natural abundance. Or does liberation come from working even
harder against our will in the wrong direction out of fear? Everyone can make this happen for themselves. Regardless our situation. We don’t need to cultivate it, we don’t
have to be rich or try really really hard, we don’t need to change our relationship,
or the place where we are living or the way we look.
Of course we are free to do any of this, but
it is not required at all. Just understanding ‘how’ we can get past
the root of all of our pain, fear and symptoms, without having to feel them again of course,
is enough. This video is limited in time, but do you
want to know how to immediately get past the symptom of fear, whenever it occurs, or do
you want to know the truth about ‘fear’ and ‘pain’ that will set you free? Click on the link above or at the end of this
video, depending on where you look at it, and this will take you to my blog and from
there I will be able to send you 4 videos, free of charge.
If you like this video, please give it a thumbs
up. If you want to help me liberate even more
people from fear, stress and pain, by making the real cause and the unhealthy wrong direction
visible, please share this video with your friends. Click on the link & I will see you in the
next video..
everyone reacts differently to stressful situations like the kovat 19 pandemic this can be a time of strong emotions in both adults and children you may feel anxious anger sadness or overwhelmed find ways to reduce your stress to help yourself and the people you care about learn the common signs of stress such as changes in sleep or eating patterns difficulty concentrating worsening or chronic health problems and increased use of alcohol tobacco or other drugs take breaks from new stories including social media take care of your body take deep breaths stretch or meditate try to eat healthy well-balanced meals exercise regularly get plenty of sleep and avoid alcohol and drugs make time to unwind try to do activities you enjoy connect with others by phone text or email share your concerns and feelings with people you trust if you or someone you know have pre-existing mental health conditions continue with treatment and be aware of new or worsening symptoms contact a health care provider with any concerns or if stress gets in the way of daily activities for several days in a row if you or someone you care about are feeling overwhelmed with emotions like sadness depression or anxiety get support by calling 1-800 nine eight five five nine nine zero or text talk with us two six six seven four six learn more at cdc.gov kovat 19 and coronavirus gov let's take care of ourselves our family and our community
(lively music) – I'm Pamela Wu and with me today is Dr. Breanna Winder-Patel
a clinical psychologist at our world renowned MIND Institute. MIND as we call it here
performs research on and provides care for
neurodevelopmental disorders. Today we're going to be
discussing how to help adults and children both with and without neurodevelopmental disorders in this time of coronavirus anxiety and lots of routine changes as well. Dr. Winder-Patel thanks for being with us. – Thanks for having me. – Many of our viewers
have been experiencing a lot of anxiety since
the coronavirus began. What have you been
seeing in your practice? – Yeah so before we get started
I just wanna mention that Dr. Meg Tudor is also a
psychologist at MIND and we work together on getting
these materials ready and then in this effort
of you know physical or social distancing
she wasn't able to come. So there's probably more
things we're gonna develop over the days to come about this and she's kind of equally involved. So I wanted to mention that and she has a similar
practice to mine at MIND. What we're seeing is that
you know this is a time of high-anxiety for a lot of people.
What underlies anxiety is we think of, has a lot to do with fear of uncertainty and worries about uncertainty, and obviously there's a
lot of uncertainty for us at this time. So we would expect people to
have some anxiety that's higher and that's a way that
we're sort of designed to look out for dangers. Some people are having some
anxiety that's even excessive for what's going on. And we have you know a mechanism called the fight, flight or freeze mechanism, that we all have for when
we're in a true danger.
And it's important for
that to go off if like a bus is coming towards
you or something like that. But it's not, we have that go off as like a false alarm sometimes and I think that's happening some. So what we're seeing in our
practice is some of the kids are talking about the coronavirus in ways where they're pretty anxious about it. But actually some aren't as
anxious as they usually are because the things that make them anxious, like separating from their parents or interacting with peers. They're not doing right
now, they're kind of at home in their safe space.
It's a lot of transition
to move to the video visits so that's been part of what
we're trying to work on to continue to provide care. – What can parents tell
children who are anxious about the coronavirus? – Yeah, so we want children to have you know specific
fact-based information. So there are a lot of
myths kind of going around and information that can
be really scary for kids, and it's best to not completely
keep them in the dark. But give them some information
so they understand like the true honest effort that
they're parent is giving to let them know about it. So for example, we would
want kids to know things like you know we would want
them to understand that people have viruses all the time and that the difference with this virus is that we don't want so many
people to get it at once, so that the hospitals and the
doctors are just too busy. So we're all really working
hard to stay at home from school and home from work to give
them the space they need to work on this virus. And for a lot of kids that's
kind of enough information obviously, it depends on their cognitive and language level.
But it's not something we need
to be talking about all day. So you know it can be,
provide some information try to get in there and
see if there's any myths the kids are walking around with, and then move on to something
more fun and relaxing like movie or a family game. – So it's not just you sort
of delivering this information to your child, but you said to sort of ask if they are thinking of any
thing that we know to be myths. So it's really like encouraging
a discussing and maybe would you ask a child say. Honey what do you know
about the coronavirus? – Yes, because we don't wanna
assume that they're having certain thoughts about
it that they're not. I had one child actually
convey to me that, and this is a child with
autism that the biggest worry was the visual image of what
everyone's putting up there that the coronavirus,
you know the depiction of what the virus would
actually look like.
– Oh the ball? – Yeah. So if you think about that ball you know, it is a scary looking ball
with red pointy things coming out of it. You know and the child's fear wasn't about getting the virus or dying. The fear was about like,
that thing looks really evil and I don't want that inside of my body. So they're interpretation
of what's going on really to this virus, was a
little bit different than what you would expect. And so you have to really see you know what is your own child thinking
about versus assuming that everybody is just
worried about getting it, 'cause that might not be it. – That's really interesting information that parents would wanna tease out.
– Yeah. – Well since schools are closed and there is an important
focus on the social distancing, which is why we're sitting
not closer together. We're sitting this far apart
at this table right now. What would be helpful
for parents to include in their daily routines with
their kids being at home? – Yeah so since this is
a time of uncertainty we would want to be able to provide them with the most kind of
structure and routine in ways that they're familiar with, so that they feel like
they know what's coming.
So we would encourage parents
to try to put some routine in place at home like
similar wake up times, knowing when meals are coming. You know knowing if
school work is expected at a certain time and when
the fun time is gonna come. We also, you know, I'm
hearing a lot of information about parents who are
expected to work from home in addition to taking
care of their children, in addition to teaching their children. And it's just so entirely
unrealistic to put the pressure of some like idealistic
schedule on these families. So I think the idea is to
try to keep some structure for the child. But also to be really
flexible and kind of you know easy on yourself that
that's not gonna happen in a perfect way everyday
and we're expected to all do things that are
really unfamiliar to us.
You know it might be a time if the child is really struggling to do the
traditional way of learning. Maybe it's a time to focus
on experiential learning that's where we think of
teaching them hands-on things like how to measure the
ingredients for you know what they're making, or going outside for a walk
and trying to identify trees or flowers that we know of. You know that type of learning
is really important too and parents are actually
doing that a lot of the time they might not realize that.
And the other thing is
to think about you know are there things that you
really loved as a child that were really meaningful
and maybe this is a time to do it. Like you know I was a big
fan of like making forts and doing scavenger hunts
and all of these things. And at the end of this we want
kids to be able to look back and not feel like wow
that was so much tension the whole time. We want it to be able to be like well, it was kinda stressful for everyone but I had some really great
experiences with my family and I learned, and now I
have some great memories.
So it's a balance and we have
to be kinda easy on ourselves at this time. – That is such good advice
I think so many families need to hear that right now. – Yeah. – We've been talking about
routine you talked about sort of developing a flexible schedule 'cause kids
like to know what's coming. A lot of children and people, adults too with neurodevelopmental disorders
really thrive on routine and for a lot families their home life has just been completely upended by this.
So what are some of the special challenges for families who have
a member of the family with a neurodevelopmental disorder? – Yeah. Well I mean I think
the biggest one is that you know in our world in
my field we talk about we don't expect the parents
to be the therapist. We expect if you need a
therapist you go to a therapist. And the same with parents being teachers, if you're not a teacher that's a really big
responsibility to put on a parent. And now like parents
are everything. (laughs) – Yeah they're right. – Right now for children with
neurodevelopmental disorders that have in-home services
that have been suspended. They're not getting that support
they need and they're not getting those therapists and
they're kind of mean to be the therapist and the teacher.
So I think the challenges
are that really the support. A lot of times individuals with
neurodevelopmental disorders have a lot of extra
therapies and interventions that aren't happening right now. So we would encourage
parents to you know keep with those strategies as they can, and see if there's other
resources they can get through you know if they have any
option for video visits with the provider, and you
know there's a resource we're going to mention
that the MIND Institute, faculty of the MIND Institute developed that might be helpful as well. So I think it's the extra
challenges are probably related to you know really feeling like they were so used to that routine and
what they did everyday, going to school going to therapy and having trouble understanding you know why is this so different and why don't we have a choice right now.
– So again just kind of
being supportive of them trying to include things
they really enjoy. Include their special
interests in their day. One thing we talk about is
that if a child has a special interest in something it
could help you explain the pandemic to them. So for example if they're
really into superheroes you could say well the
healthcare workers are kind of like Iron Man, and their job right now is to go after this thing that they're trying
to you know fight against, and we need to give them
to space to do that. And you know eventually,
you know Iron Man defeats the Mandarin just like we're helping the healthcare workers defeat the virus. So sometimes pulling in
their special interests can give them some feel
like they have some control and some better understanding. But it's really just about
trying to keep the routine the same but also being
understanding that you know, that's a huge expectation. – Absolutely, you mentioned
that sometimes kids might not be as scared as we think they are. Because we're so immersed in the news and so there is a lot
of fear among adults, but kids might not be as scared.
For kids who are scared though
like the one that you said was scared of the scary
red ball entering his body. What can parents do to support those kids and give them a feeling of security? – Yeah great question. So one of the things that we
think about with thoughts. If we're having a lot of what if thoughts, that's usually a sign
it's an anxious thought. Because we're asking like
what if the bad thing happens and we don't know yet
cause it's uncertain, it's in the future. So if you're hearing a
lot of what if thoughts from the child, you know
it's a tendency for parents to just say like oh don't
worry or it'll be okay.
But for some kids that
reassurance doesn't work and part of why that
doesn't work is because they have this thought
and it's not going away. So we have a strategy of getting
the child to look for proof for their thoughts. So you know if your thought
is what if I'm going to get very sick and die. Looking for proof would be
saying things like oh you know is anyone in my house sick? Are we responsible with
the physical distancing you know that we're doing? Are we washing our hands? Do I have any proof that I'm actually in a
true danger right now? And if that proof isn't there,
then we have to question is anxiety telling us the truth.
So we talk about externalizing the anxiety and being able to decide
whether to listen to it or not. So if you look for proof and you realize you don't really have any, that the anxiety is telling you the truth. Then we encourage children
and adults to do something called change the channel in your mind, that's what we call it. So we teach little kids,
your mind is like a TV and if you're kinda stuck
on the anxiety channel and it's not helpful for you.
We have to kinda let that
channel go and switch it over to something that's calming and relaxing. I, this week was like I need
to find something personally to change my channel, and so I found the book called Joyful. It's about you know looking
around in the physical world and understanding how
it impacts inner-joy. So if I'm having these thoughts that are not helpful right
now I change my channel to either thinking about
the ideas in the book or even like If I can take a break, going and listening to it.
I may or may not have
been hiding in my closet listening to it last night. (both laughs) – Change it to the joyful channel. – Right right. So it's you know things
like this that adults need to implement too because
we have the worries as well but we also have many
of us the responsibility of taking care of our children. – Yeah. That leads me actually
to my next question. How important it is for
adults to sort of model this calm behavior for kids? Because I feel like they
really pick up on our energy that way if we're really anxious. – Yeah they do, they're
just little investigators. They're very observant and aware more than what we often realize. And I think that there's
specific ways they could model some of these skills right now. We think a lot about how
problem solving is helpful.
So if you have a problem and
it can be solved you're going to feel less anxious. So an example would be if a
parent is trying to switch over a doctor's appointment or
a class to a video visit and they can do that. They could model for the child,
oh mommy had this problem, we're not able to go to the
visit so here's what I did to problem solve it and
wow I feel better now that I did that. If you can't problem solve something, really the other option is to
cope with it in healthy ways. So again like try to switch
over to a video visit, it didn't work. Well, I did what I could and now I just need to change my channel to either listening to music, or playing a game with the family.
'Cause it's not gonna help me
to keep worrying about that. So that's something you
know that parents can model and really this idea of problem
solve something when you can and cope in healthy ways when you can't is probably helpful for
all of us right now. – Yeah. – And so it's something
that parents you know can model when they
can for their children.
But also realize that again
they're not gonna be the perfect teacher and therapist
and everything right now because we just think that's unrealistic. – What additional challenges
might there be for people with autism or other
neurodevelopmental disorders that we haven't talked about yet? – I think that you know
the one that I mentioned is that piece about some
individuals with autism have heightened visual
abilities and visual memory. So this piece about you know
that child seeing that image of the you know the way they're
depicting the virus looking really stuck with him. And maybe not in a way that it would stick with other people. So we have to be careful of
what they're being exposed to right now because it's just a lot of information that's confusing. And both on the side of the visual stuff can be difficult for
them because if that's something that gets stuck in their mind it can be hard to shift off of it.
On the other hand, you
know you can do things to help support the visual
strengths right now, like having children
draw how they're feeling rather than talking to them about it. That's something that
we do a lot in therapy with kids with autism to you
know get their perspectives on how they're doing. The other things it sort of
just depends on the child. There's actually an area of
anxiety that we're researching at the MIND Institute. It was developed by a
psychologist named Connor Kerns and it's called fear of change, and it's something that we see more often in kids with autism. So it's this idea of being
anxious about changing routines or change in schedules. So the kids that were
already having difficulty in that area are probably
really struggling right now.
They probably never had an
experience in their life where their schedule has changed
to such an extreme degree. And you know parents have
to just do their best to make them comfortable
and help them cope and help them find things
that will reduce their anxiety like providing a visual
schedule for them at home, you know that's reasonable and help supporting them in those ways. – When is it time, at
what point should someone go see a professional when their anxiety has gotten the best of them? – So we have a, in the
one interview we do.
We talk about when anxiety gets turned on like a light switch and you
can no longer turn it off is where you're kinda hitting that point of thinking wow, this is at that level that we might really need
to do something about it. And if in the other concept that we think a lot about is interference. So if you just get anxious and
you kind of think about it, your parent gives you
reassurance and you feel better that's one thing. But if you get anxious and then you know you can't even get on the
phone to talk to grandma 'cause you're so anxious
and you can't even you know walk outside because you're so anxious. It's that level of interference that often makes the decision of that like is this to that problem
point that we'd really need to seek care. I think what's going on right now is that it's more typical than not to
feel some anxiety you know. So we would want to you
know help support kids during this time and then
see once this calms down is the anxiety still staying high, and to help them seek support if so.
– We're not suppose to
leave our homes right now unless we are on essential business or running an essential errand. You can still see a provider
here at UC Davis Health without having to leave your home. Can you talk to us about video visits and how many more video
visits you've been seeing? Yeah, so we, because we're
not seeing patients in person our staff in the MIND Institute
and also in psychiatry worked really hard to get
everything transferred over to video visits. It's a way of doing tele-health that we can do through MyChart. And so all of my therapy patients have been transferred over. It's a little bit strange
at first you know, I see some little kids and they're sort of my big head pops up on the
screen and they're like ah.
(both laughs) – Right on their tablet
or their I-phone at home. – Yeah they're like in
their bed or whatever. And so parents have been great
about like supporting them and do you want me to stay
here 'cause often you know I have a portion of the session
with the child just alone. So again it's that idea of flexibility. We have to do a lot of
things that don't feel like our usual way of doing things.
And most of them have been really great and the patients that I'm,
you know I've been underway with treatment and we're
in the middle of it. We already have goals
we're setting you know they understand the format. It's just that they're
sitting at home rather than being in person. Anxiety therapy has a big
focus on what we call exposure, so it's about facing the
things you're scared of, and Dr. Meg Tudor and I do
a lot of these exposures with patients when they come in. So that's a little tricky
because we would do the exposures with the patient first. Like a child who's you know
very very scared of germs and doesn't wanna touch doorknobs.
We would work with them
and encourage them you know to touch a doorknob with us. So if they're not with
us in person you know we are being creative
about how much we can ask the parents to do at
home and how can still get that really important
part of therapy addressed. But we feel like at the very
least if we can be supportive and continue to work on our
goals that would be one part of consistency in their lives right now. – Yeah. For those of you who are interested in learning more about video visits. You can contact UC Davis
Health, contact your provider at UC Davis Health. You can find instructions
online on how to do it as well and through what we
call My UC Davis online. It's the app or our
providers call it MyChart. So you can learn more that way. It's a really really great resource. Let's keep talking about resources.
You are involved in something
called the STAAR Study. – Yeah so the STAAR Study
is, it stands for specifying and treating anxiety and autism research. So it's specific to kids
eight to 14-years-old who have autism and have
significant anxiety. So right now there is
you know a lot of anxiety going on in a lot of people,
that'll probably go down when this gets better. For kids that we're
looking for for this study it would be kids who have
more higher level of anxiety that's kind of persisting and
we have this treatment study. So the study is that if they qualified for the screening criteria
they would be randomized to either cognitive behavioral therapy or medication group which is sertraline or pill placebo group. And they would see us in the office, the main part of the study is 16 weeks and then there's follow ups. So we right now, since we're
not seeing people in person, we aren't doing any of the,
starting any of the visits but we are doing the phone screens and we're trying to you
know capture information on families that would be interested now, and then we would be able to bring them in when it's safer.
So if people are interesting in that study the contact person is Taron Heckers and her phone number is 916-703-0119. – So if you're interested
you can learn more that can be available to you. – Okay, yeah that's great. – MIND has a new web platform too for, that contains resources
for families and caregivers of kids with autism and it's
really excellent for shelter and place time. – Yes, it is called helpisinyourhands.org. So that's actually the
website helpisinyourhands.org, and it's a free website that was developed by doctors
Aubyn Stahmer and Sally Rogers of the MIND Institute. And it was developed to help caregivers with skills to assist them in working with their children with autism. So it's based on the
early start Denver model. Which is something that that's the model they've been working on and
researching for a long time.
– Is that the early intervention? – Yes. So this is targeted towards children who are like zero to three
years of age very young children and the website has these video modules that can kind of show
you how you could work on some of these skills
with your child with autism or showing signs of autism. And I signed up on it today to you know that a thorough look,
it's very easy to sign up. It can be used on I
believe I-phones, I-pads lots of devices and again
it's completely free. – Is there anything else
that you'd like to add for our viewers who are dealing with anxiety,
sheltering and place? – Yeah I mean one other
resource that you know, I don't know if we'll be able to post. But Dr. Pakyurek is our division chief of child and adolescent psychiatry. And he was interviewed by KCRA on you know how psychiatry is handling this as well.
I think similar to us we're
switching to these video visits. And I think other things are
really there's the lovely part of social media right now
is that parents are posting a lot of really creative
things that people can do with their kids at home. You know some examples I've
seen are you know I mentioned my favorites of my scavenger
hunts and my forts. But there's a website where
celebrities will read books to your children.
There's another website where
a famous children author will do doodle, do a doodle that your, and it's kind of you know
he's doing it kind of live and your children can do it, and there's zoos that are showing animals. So we don't want people to
you know slip into doing a massive amount of screen
time because we want kids to get physical activity, and to get these productive activities. But there's been some
pretty creative ways set up for children to access you know learning and maybe have some time on screens that could be really
fun and really unique. – And productive and comforting
to kids and parents alike. – Yes yes. – [Interviewer] So someone asked that their granddaughter's anxiety is surfacing in the way of controlling
behavior regarding her classwork. Do you have any suggestions
on how this person can help their granddaughter prime
in order to be ready to do classwork at home
versus in the classroom? – So you know I think one
thing that can be helpful is before classwork has started
to bring right before it an activity that's likely to
be more relaxing or settling.
So you know depending
on what options you have within the boundaries of your house. But swinging on a swing
or jumping on a trampoline or doing something physical
like that to kind of calm the body and mind and get
it ready for the work. The other thing is maybe
it's just confusing what's expected at home or the work times are a little bit longer than
what the child's used to. So maybe starting out with
just doing like a few problems and saying we do a couple
minutes and then we take a break and we get a fun reward to help start this you know new process that she's
probably not used to doing. – So really, I mean it's just
a time of change for everyone. – Yes, yes. – And your message of flexibility
I think is so important. – Yeah and you can even get really specific about flexibility. So I've talked to a few kids
on my video visits this week about like that do you know
what flexibility means, and couple of them were like nope.
(laughs) And I'm like well, it means
you know when there's something that we're used to doing one way and we really are encouraged
to do it another way to sort of be willing to try. You know for the sake of
maybe yourself or the family. So you can even say to kids like you know, something I might say is well this morning I had to be flexible when my child was like tapping on my face and asking me to sing Old McDonald before it was wake up time. – How fun for you. – So yeah. So I was flexible this
morning so now I'm asking you to you know sit down do this
or you know eat your lunch at a time you're not used to. Let's see if you can get
some flexibility points. And you can you know reinforce
them by giving them points for it and making it kinda like a game like who can be the most flexible today. Because they think that's
so much of this adapting and being flexible is just not
something where you know kids are like really used to working on.
And so if we explicitly
describe it to them and then give them a chance to try it, that might help as well. – For more coronavirus information
from our reliable sources here at UC Davis Health, please visit
health.ucdavis.edu/coronavirus. Thanks again for being with us. (soft music).
Good afternoon and welcome to CCK live. My name is Jenna Zellmer and joining me today are Alyse Galoski and Nick Briggs We all work on Veterans Benefits appeals here at CCK And today we're gonna be talking about anxiety. Now before we get into it I just wanted to remind you all that if you have any questions or comments during our conversation You can go ahead and leave them in the comment box below You will also be posting links to blogs and more information on our website at CCK-LAW.com So let's get into it.
So Nick, why don't you start us off? We're gonna be talking about both service connection and increased rating for anxiety today Let's start with talking about service connection So Nick what are some common anxiety disorders that veterans can claim service connection for? Sure So one of the more common types that we see are generalized anxiety disorders But there are also other specific types of anxiety disorders like social anxiety, Panic disorders, and then specific phobias like agoraphobia. Okay.
And Alyse, what are some common symptoms that characterize these anxiety disorders? Sure So there's some of those like invisible symptoms like excessive worry or difficulty concentrating but then there's also symptoms that physically manifest so you can Feel jumpy or you might be dizzy, have difficulty sleeping have mental have muscle tension feel nauseous or even lightheaded. So these are all manifestations of an underlying anxiety condition and I think that it's really important. I think a lot of times veterans Think that they can only give service-connected for PTSD because I think that you know often PTSD is goes in hand-in-hand with a lot of experiences the veterans experience in service but Even though anxiety disorders are a little bit different if you go to your doctor, and they don't diagnose you with PTSD But they do diagnose you with any of these symptoms or any of the anxiety disorders that Nick mentioned And you can still claim service-connection for that specific condition.
So What do veterans need in order to show service connection for this condition? So the first and most important thing that you want to be able to demonstrate is in service incurrence And that can take a number of different forms either the veterans specifically treats for and is diagnosed with an anxiety disorder in service They might just check that they were experiencing depression or excessive worry on their discharge Examination or there might have been some specific incident that they remember that caused their anxiety, and it's continued to persist since then You don't need to be diagnosed with anxiety. Sure. Okay, you just have to have some sort of notation. Alyse, what else? What after an in-service occurrence, what else do you need? First thing that you need is a Nexus so, that's what's gonna Connect both your in service condition to what's going on with you now Typically that's gonna require some type of medical opinion because lay persons are not competent typically to make that connection so It's a medical opinion Usually that's gonna draw that nexus.
And we have a Facebook live All about what you need to show all three elements of service connection, so we'll link that In our notes, and if you want more information just on general service connection. You can check us out there So Alyse you had mentioned that you need a nexus and that generally requires an examination or medical determination so, how do C&P exams which is what we also call them which stands for compensation and pension exam How do those work in relation to anxiety conditions? What would happen in a service connection for anxiety claim? Sure So typically with a C&P exam you're going to be meeting with a VA physician Who it's gonna be somebody that you've never met before most likely they will ask you about your experiences during service They'll also ask you about experiences that you have now.
They may also ask you about Any medical history any family medical history It's gonna be a lot of questions that are all gonna be what they're gonna use to Support an opinion on as to whether what's what you have now is related to service or not So it's gonna be a lot of those background questions family medical questions And they'll also ask you about what your current symptoms are. Mm-hmm And I think we also have a Facebook live all about C&P examinations Which has a lot of great information kind of explaining what's gonna happen in these exams and what you should and shouldn't you do. I think the biggest thing is you have to always show up for your examinations and then if you get an unfavorable opinion Nick, what are some remedies that the veteran can pursue? Sure Well oftentimes a veteran won't necessarily know that the opinion was negative until they get the next decision from VA denying their claim so first and foremost They need to make sure that they're requesting a copy of their VA examination which they're entitled to do And then once they have the exam they should go through it at length making sure to identify any specific problems that they noticed or things that they think Conflict with other evidence they've submitted before one of the things that VA examiner's are supposed to do is review the claims file and make sure that they're looking at Everything the veterans submitted including lay evidence and then considering all of those things in light of the examination itself Great.
Um, I think you know the one important thing that I heard you saying that is lay evidence So, you know, we've talked about medical evidence and why we need that usually for a nexus But can you talk a little bit about what other kind of evidence including lay evidence You might need to support a claim for anxiety? Sure lay evidence is often one of the things we go to most often if only because a lot of the time veterans don't feel comfortable seeking treatment for their condition during service or even afterward because it's something that you know, It's kind of stigmatized and people don't necessarily like to talk about it so it could be many years before they actually go get to the point where they feel they need to seek treatment and Lay evidence from the veteran him or herself and all their family members can help fill in some of those gaps But whenever possible it's also a good idea to submit treatment information from either your VA doctors or any private psychologists that you see.
So Let's kind of take a step back and talk about The Appeals Modernization Act. So we have a whole Facebook live on the AMA as we call it essentially back in February VA totally revamped their appeal system and so now There are several different Avenues that a veteran can pursue after they receive a unfavorable rating decision. So if A veteran, you know wants to file an appeal. What should they kind of know about the AMA? After they receive a rating decision from VA? Sure So the most important thing is that if their claim was previously denied and they're filing a supplemental claim Which is one of the new options under the appeals modernization system. They need to make sure that they're submitting new and relevant evidence That's meant to be a relatively relaxed evidentiary standard So it could be something as simple as providing a lay statement talking about how their symptoms are related to service Um, it could be submitting medical evidence establishing that they have a current diagnosis.
But whatever it is, it needs to be something that is relevant to their claim And then they can also pursue taking their case to the board with or without submitting additional evidence if they really do think That it's a situation where the regional office is just getting it wrong. But all of those options are still available to them They just need to be conscious of the 1-year time frames. Great. Yeah, I think You know, the AMA is a pretty new system and it's pretty complicated Although it is supposed to provide veterans with more choices, and it's supposed to clarify a lot of things I think it's still unclear kind of how it's going to work for veterans so we would really encourage you if you're seeking to initiate an appeal under the AMA to Consult your veteran service organization or an attorney.
Someone who has some expertise in this area of law And as I mentioned, we'll link some more information to the AMA in the case notes or in the in the comments below so we're talking about service connection and we mentioned in-service incurrence a Nexus and a current, you know disability What if a veteran doesn't have an in-service occurrence can the veteran get service connection another way Alyse? Yes. So an alternative way to get service connection is called secondary service connection This happens when you have an already service-connected disability, that is either causing or aggravating Your anxiety or a second condition So say that you have just for example you have a knee condition and your knee condition causes you a lot of pain and It makes you anxious to to get out of bed. It makes you anxious to walk down the street or to walk to work You could potentially show that you have secondary service connection for your anxiety because your knee conditions already service-connected whether it's either causing or Aggravating an already, you know existing anxiety condition Yeah, I think that anxiety is something that a lot of veterans probably have secondary to their service connected disabilities, especially physical disabilities I think In your example for example If the veteran had a lot of instability in their knee and they were never sure whether or not they were gonna fall You know I can imagine that causing a lot of anxiety And so just the same way that you would need a nexus opinion for direct service connection You would still want to get a doctor to make an opinion about whether or not that knee causes or aggravates anxiety.
Really good So let's assume that a veteran has received service connection, you know, they've met that first threshold Either secondary or direct. Let's talk about how VA rates anxiety. So Let's take a step back a little bit and talk about kind of how VA rates things in general and I think that we do Have some information on that in our past Facebook lives Alyse you want to talk a little bit about what Diagnostic codes are? And what the diagnostic code for anxiety is? Sure So if you think about the diagnostic code the best way think of it is it's this rubric Where they where the VA has established certain Disabilities and under those disabilities are certain rubrics.
If you meet certain criteria under the rubric then you're granted You should be granted or certain rating specifically anxiety is rated under the general formula for medical or mental rather disorders So that's gonna also include other Mental disorders which could be schizophrenia. It could also be PTSD the very many different types of anxiety there are and probably any other type of Mental condition that you can think of are all rated under the same Diagnostic code that's going to be diagnostic 4.130 That diagnostic code goes up to 100% It starts at a non-compensable rating of 0% And it lists specific symptoms and overall functional impairment that you would have to meet to Get a specific rating So Nick, Alyse mentioned that kind of several different Psychiatric conditions are all rated under this one general formula.
So what Happens if the veteran has for example, both anxiety and PTSD or anxiety and depression? Does that affect your rating at all? Sure, so like Alyse mentioned, you know, even though individual psychiatric conditions do have their own diagnostic codes they're all rated under this general formula and Because of that and because they're all rated based off of the same criteria of factoring it in the same symptoms You're not going to receive separate ratings for each individual mental health condition. They're going to figure out which symptoms are imposed by each of those conditions and then give you one overall rating using the general formula. Good and I think it's important to kind of keep that in mind when you're looking at your rating code sheet, you know, every rating decision comes with the code sheet that lists out all of your disabilities and over the course of your life and your different appeals your rating for your psych condition can change and the Characterization of your psych condition can change based on what VA determines– kind of what the diagnosis you have so for example you know veterans who were service-connected a long time ago for psychiatric conditions might be originally rated under something called like a nervous condition and then as you know medical information has kind of evolved that could get re-characterized as PTSD or anxiety and then sometimes You know a veteran could be service connected for one thing and then later on claim service connection for another psychiatric condition As Nick said you're not gonna get a separate rating for that second condition But they might recharacterize what it's called on your code sheet and so that's important to keep in mind and just to make sure that you know, if There are symptoms that weren't originally Compensated under your original characterization, but you feel are now Encompassed in that in that characterization you might want to make a claim for an increase rating.
So, you know Alyse you mentioned the different possible rating levels and you mentioned that The diagnostic code and the rating formula provides different symptoms and different criteria that you need to meet in order to get to a higher rating so Do veterans have to meet every single criteria in that rating in order to get to the higher rating? No. So technically you don't even have to meet a single one of the criteria What you have to do is show that your functional loss is similar and what's called severity frequency and duration To the type of symptoms and functional loss listed in this diagnostic code. So if you receive a board decision that says, "The veteran is not entitled to a higher rating because he does because although he has certain symptoms in the seventy Criteria, he does not have them all that would be error" You don't have to meet all of their criteria What you have to do is show that your functional loss is overall similar in severity duration and frequency To these types of symptoms that they're listing it's a list.
It's a non exhaustive list and it's really just supposed to be examples And there are two cases that kind of go to that point about this, Claudio and Mauer. Yes, so For those of you who kind of want to take a little deeper into the case law The court has made clear that these symptoms are not required. So Nick what happens if a veteran's condition is so severe that they actually have to get hospitalized? Sure so periods of Hospitalization are considered to be totally disabling So in a situation where a veteran's hospitalized due to their mental health disability for more than 21 days They're entitled to a 100% rating for the period of the hospitalization But if the veteran is hospitalized for an extended stay of more than six months They're not only assigned the 100% rating for the entire length of the hospitalization But as well as six additional months after the date of their discharge I think that makes sense.
If you think about how VA rates disabilities and that the ratings are supposed to be based on Impairment in earning capacity. So obviously if a veteran is hospitalized they can't be working and so, you know It's really important if you do get hospitalized you want to make sure that you Tell VA and make sure the VA is appropriately compensating you so that's really important to keep that in mind and then you know I think that a lot of times when the veterans are going to seek treatment or they're seeking a VA examination They get something called GAF scores GAF So Alyse, do you want to talk about a little bit about GAF scores and whether or not they're even still relevant or what? What's going on with GAFscores? Sure so a GAF score is a somewhat or outdated way that Practitioners used to measure how severe a person's psychiatric disorder was it is from a previous version of the DSM a VA has since come out with a court decision called golden which says that those GAF scores are No longer in the dsm-5 and therefore they're they're outdated and they shouldn't be used by the board So in some circumstances, you might still see them mentioned your board decisions But the board really shouldn't be relying on them to deny you a higher rating Yeah, and if you see the board talk about gaps scores in relation to what rating you should be receiving That should be a red flag and and you can talk to you know An attorney or a VSO about potentially appealing that decision to the board Or to the court, excuse me, And Alyse mentioned the DSM.
So the DSM stands for Diagnostic Statistical Manual it's the manual that all Mental health professionals use in diagnosing mental health conditions. So we have a question from Stephen can you explain the difference between occupational and social impairment with reduced reliability and productivity and occupational and social impairment with deficiencies in most areas So these are the criteria for the 50 and the 70% ratings and this is actually an excellent question so. I'm smiling stephen Because it is a very good question and it's one that the board has not yet answered for us Yeah the court or the court, rather. so They haven't provided exact definitions of what those things mean But if you look to the diagnostic code, you can try and get a sense of what types of symptoms fall under each of those But unfortunately they don't have like, a You know a straight answer for you because the court and the board– VA have not defined it further than what we already see In the code, you can look at some of the symptoms for example in the 50% What is contemplated by occupational and social impairment with reduced reliability and productivity include flattened effect Panic attacks more than once a week impaired judgment impaired abstract thinking difficulty in establishing and maintaining social Relationships in the step higher you're seeing it involve more areas of your life Other than just the occupation and some of your relationships.
You're also seeing suicidal ideation obsessive rituals Near-continuous panic rather than panic attacks once a week. You're seeing an inability to establish and maintain Effective relationships now what we were saying before you do not need to show all of these symptoms It's just meant to be a list of examples to give you an idea of what that level of functional loss is. Precisely Become the different ratings are so vague. Right. What is the difference between reduce reduced reliability and Deficiencies in most areas? And so you use the symptoms in order to kind of parse that out but as Alyse said, you know, the court hasn't really given us a lot of guidance on this and that results in a lot of wildly, inconsistent board decisions And that's –sorry Nope, go ahead. That's what makes the board's Requirement to provide adequate reasons and bases so important because they don't have a strict definition of what these things mean They're really supposed to be properly explaining to you As the veteran why you're not entitled to a higher rating With what we call adequate reasons and basis.
Yeah and it's especially important in the Context of anxiety disorders because often times it's the type of mental health illness that might only really manifest itself in two or three specific Symptoms where it's the overwhelming anxiety and frequent panic attacks that are causing you to be unable to function in these areas But because VA tends to rely on the number of symptoms that you have rather than how severe they are It can get complicated especially when they're not really Defining the concepts that they're using. Right, sure that goes back to what Alyse was saying about It's really focusing on the frequency severity and duration of these symptoms And so if you see VA kind of using this rating criteria as a checklist that should you know You know raise a red flag that it's probably not a very good decision and that you could potentially appeal it yeah, I think that's a really good point Nick, especially because we are talking about anxiety, which is not a condition that Typically actually manifests itself into a lot of the symptoms that you see in the highest 100% rating like hallucination But if you for example have such severe agoraphobia that you can't leave your house or can't leave your room Then you might have total occupational social impairment.
So even though a Agoraphobia isn't a symptom listed under the 100% the overall functional loss might be enough to get you there. Mm-hmm so it's a really great question and I think it's just it really highlights why this area of law is so Unclear and why it's important to You know consult with your VSO or consult with an attorney because they can kind of navigate this and figure out what the best solution or argument to make in your case is. Great so We talked about GAF scores And the DSM, so I think the next thing that we want to talk about is what happens if a mental health condition Overlaps a non psychiatric condition Nick. Do you want to talk about that? I mean It's a concept we talk about a lot called pyramiding and I think we have our own Facebook live sessions on that topic So, please refer to that if you have any more detailed questions but the basic idea is that VA is only going to compensate each symptom that a veteran experiences once so if the veteran Experiences or suffers from an orthopedic disability that causes sleep impairment and then a psychiatric disability that causes sleep impairment They're gonna generally rate that symptom under one of those diagnostic codes one of those conditions and then not rate it under the other one just to make sure that they're not overcompensating the veteran for the symptom.
Then I think that the kind of reverse of that is what Alyse was mentioning earlier as if your psychiatric condition results in non psychiatric symptoms then you can potentially get It's like the opposite of pyramiding it's when pyramiding isn't a problem is when there are distinct manifestations of Your condition and you can get separate ratings for that. So, um, we talked a little bit about this in terms of total occupational and social impairment But what happens if a veteran's anxiety prevents them from working? Sure, so there is an avenue to receive a 100% rating called tdiu this is what you may be entitled for if your Disabilities could be your anxiety alone or your anxiety combined with all of your other service-connected disabilities prevent you from obtaining securing what's called substantial gainful employment So this is actually a lower standard than total occupational impairment substantially gainful employment is another one of those terms that we're working on having, you know, getting a really good definition for But basically it is something that is more than just a marginal employment something that is more than what we call protected work environment and If somebody if somebody's anxiety or somebody's anxiety combined with their other disabilities prevent them from really obtaining Secure employment then they might be entitled to to TDIU we have Absolutely have a lot of information on their website about tdiu.
That is a very large area of veterans law But it so if you have any questions about that Absolutely advise you to look at our website as well as well our other– I'm sure there's a Facebook you're live on that as well. Definitely So what other kinds of evidence? Should veterans be kind of collecting and submitting in order to support their increased rating claims, Nick? we've mentioned it a few times in the context of service connection, but it applies equally well to Increased ratings and that's lay evidence Obviously the veteran will only see their treating provider or a VA doctor every so often There are going to be months or even years where they don't seek treatment But the people who know them who live with them who experience their symptoms on the day to day basis are often in the best Position to provide a description of you know, what those symptoms are and how they affect them I'm so getting statements from yourself getting statements from family members can go a long way And I think you know one of the most common mistakes I see in that situation is at the board or VA Provides or assigned more value to those treatment records as opposed to the lay statements and as Nick said I think it's really important to kind of highlight that they are both equally valuable and that they are probably complementary in most situations so even though a veteran You know might go to treatment and might not be super-severe on that one day he goes to treatment if he has all these lay statements filling in the gaps between treatment you can kind of get a bigger picture so That's kind of one of the more common mistakes that I see VA making Just to kind of wrap things up Do you guys have any other? thoughts on common mistakes VA makes in adjudicating anxiety claims or things that you think letter and should remember when they're making these claims? One thing actually it's along the lines of lay statements if you are submitting lay statements and this is kind of a new one Make sure that what you're submitting is legible because you'll want to make it easy for VA to agree with you So if they can't really read your handwriting then it's very difficult for them to understand what symptoms or what your story is.
So I just suggest whether you're typing it or in very neat handwriting lay statements should be Legible easy to understand make it easy for them to want to give you an increased rating. That's really good advice It's better for us too Another common example we see in the case of service connection is VA improperly requiring a verified stressor Which is something that's only really in place for post-traumatic stress disorder So most veterans are probably most familiar with PTSD.
So that tends to be the condition that they claim But VA is supposed to construe that Claim broadly and liberally so the veteran might end up being diagnosed with a different mental health disability But because they claimed PTSD initially VA will often get stuck on trying to adjudicate the claim at way But at the end of the day like we talked about before it's really just all about establishing Anxiety in service or reports of anxiety and then symptoms afterward. That's really good Great.
Um Thank you for joining us today. We will be back next week and we hope that you check out all the information we provided.
Hi, I am Dr Sweta Gupta Clinical Director at Medicover fertility. Today I am going to discuss Sperm Motility.
What is it, What causes low sperm motility and how low sperm motility affects pregnancy? There are three main parameters that are looked at in a semen sample to determine the fertility status of a man.
They are count morphology and sperm motility.
What is Sperm Motility Sperm motility is the ability of the sperm to move For conception to occur.
The sperms need to swim forward towards the egg and fertilise it before it disintegrates.
According to WHO s latest criteria.
At least 40 of the sperms should be moving in a given semen sample.
This is called the total motile sperm count And, among them, 32 should have a rapid forward movement.
This is called progressive motility.
What is low sperm, motility Low sperm motility is technically known as asthenospermia or asthenozoospermia, and is diagnosed when the sperms that can move efficiently are less than 32. It means that the sperms find it difficult to move towards the egg due to its limited motility.
What affects sperm motility, The most important factor affecting the quality of sperm is stress and some health conditions Also excess heat around the genitals increases scrotal temperature that can affect the motility of sperm.
It is also advised to avoid excessive consumption of alcohol and smoking.
How low sperm motility affects pregnancy? If a man has low sperm motility, then he might be diagnosed with male factor infertility Because after ovulation, an egg stays in the fallopian tube for 12 24 hours waiting for the sperm to fertilise it.
If the sperms have low motility, then they would not be able to swim up the uterus to reach the fallopian tubes in time to fertilise the egg, thereby affecting pregnancy.
What are the treatment options for low sperm motility If a couple is facing an issue in conceiving due to low sperm motility and have tried fertility drugs like clomiphene, to increase motility? But without any luck then best is resorting to Assisted Reproductive Technology ART to conceive successfully The available options are IUI.
Intrauterine insemination is recommended when the sperm motility range is between 30 40.
This procedure saves the sperm from taking the long journey from the cervix to the fallopian tube, thus making it easier to reach the egg IVF In vitro fertilisation is recommended when the sperm motility is lower than 30 ICSI Intracytoplasmic sperm injection is recommended in men with severe Motility issues: How can Medicover Fertility help males with low sperm motility Medicover fertility clinics are among the top fertility clinics in Europe.
Now in India, With state of the art, technology and technical expertise of doctors, we have been successfully treating men with fertility issues.
We have many low sperm motility success stories to share, as we have treated many cases of low sperm motility where patients had come to us after failed IUI and IVF s. Thank you for watching this video.
If you have any questions or concerns regarding low sperm motility, you can drop your questions in the comment section or call us on 7862800700 .
Dexamyl (or Drinamyl in the UK) was the brand name of a combination drug composed of amobarbital (previously called amylbarbitone) and dextroamphetamine. It was widely abused and is no longer manufactured. First introduced in 1950 by Smith, Kline, and French, Dexamyl was marketed as an antidepressant medication that did not cause agitation, and also as an anti-anxiety drug and diet drug. Amphetamine alone had previously been marketed as an antidepressant (under the Benzedrine Sulfate brand) beginning around 1938. The amphetamine in Dexamyl was intended to elevate mood, while the barbiturate was added to counter the side effects of the amphetamine. Its name is a portmanteau of dextroamphetamine and amylbarbitone.
Dexamyl was discontinued in the 1970s in favor of MAO inhibitors and tricyclic antidepressants.see more at WikipediaCheck More at https://htm211.com/track.php?c=cmlkPTc1NDI5NiZhaWQ9NjIyNTgxODI
The anti-gun group @Everytown took a victory lap earlier today on Twitter and bragged that they were able to get the Trader Joe’s grocery store chain to get customers to “leave their guns at home.”Well, not really. Here’s Dana Loesch with the truth:From the Forbes link in Dana’s tweet:
The companys director of public relations Alison Mochizuki told Forbes that while the chain prefers that shoppers leave weapons of any kind at home, they follow local gun laws:In general, at Trader Joes, the policies we create and follow are for ourselves and cover our own behavior. We have an explicit policy that prohibits our Crew Members (employees) from possessing firearmsor any other type of weaponwhile performing job duties, while on company property, or while at company-related events. We do not presume to control our customers behavior through grocery store policy.Our approach has always been to follow local laws; for example, New Mexico specifically prohibits open carry in stores that sell alcohol for off-site consumption. In Texas, we follow a new change in the law (Section 30.07, effective Jan. 1, 2016), maintaining what has been in place: basically, openly carried handguns will not be allowed in Trader Joes stores in Texas.We feel gun policy should be addressed by governmental and law enforcement agencies.To be clear, we do not welcome weapons of any kind in our stores and never have. While there are laws in place allowing for openly carrying firearms, we would very much prefer that customers not bring guns into our stores.We acknowledge and respect the rights of everyone involved in this important, often emotionally charged, debate. As we do with other important issues related to our business, we listen to our customers and Crewand use the feedback we receive in our decision making.
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