Visiting with people and taking phone calls can be exhausting.

And with every activity — “preparing meals, ironing a shirt, putzing around the house” — she has to pace herself.

“I have to break down tasks little by little,” Malott said. “What I can do today, I might not be able to do tomorrow.”

Chronic fatigue syndrome, also known as myalgic encephalopathy, is a devastating and little-understood disorder, characterized by an overwhelming lack of energy and a variety of other symptoms, including muscle pain, memory problems, swollen lymph nodes, sore throat, achy joints and unrestful sleep.

Malott, 49, has been living with the disorder for more than five years.

She has had to give up a 28-year nursing career, can no longer work out at the gym and now attends church from her red leather recliner at home, via the Internet.

But that hasn’t stopped her from being the best mother she can be to her children, Sara, 9 and Luke, 7.

And it doesn’t diminish her capacity to give and receive love.

“Before the illness, I was a very active mom. I would run through the door, start supper, round up the children for baths, run here, run there. Parenting was more of a task-based role,” Malott shared. “Now, it’s more emotional, supportive and educational.”

Malott said she “didn’t see this right away, but there are some gifts in this for my kids. their mom is home every morning and every evening when they come home, without fail. they will have a heart for people with illness and disability and they will benefit from the fact that I have greatly increased my efforts to educate them about life’s lessons and not taking anything for granted.”

Malott married her husband Jason when she was 38 and had her daughter Sara when she was 39, followed by a son, Luke.

“It was six months after Luke was born that I started to experience some health issues that now, in retrospect, were related to the illness,” she said.

“I was a very hands-on kind of mom and would get on the floor and play and run around in the yard with the children. I remember thinking how much I couldn’t wait to ride roller coaster with my kids. I was a front-seat, hands-up kind of girl.”

Little did she know, she reflected, how drastically her life would change.

The diagnosis

Malott said it was March of 2006 when she began to experience hand pain for about three weeks.

“I didn’t feel well,” she recalled. “So I went to my primary care doctor who sent me for carpal tunnel testing, which was negative. then, about three days later, I just felt really tired — flu-like, but also lightheaded.”

At the time, she said, she was taking a spinning class three to four times a week. When she got on the treadmill at the fitness center and started walking, “I felt like I was going to pass out. I told my husband I didn’t feel right and thought I needed to go to the emergency room. I went, and as it turns out, my heart was beating irregularly and my potassium was low.”

Malott said she had a cardiac catheterization and other cardiac tests that came back normal.

Six months later, she once again began suffering from extreme hand pain, as well as a fever and body aches that lasted 10 days.

“I could barely function,” she said. “All I could do was lay down and get up for meals and go to the bathroom. I felt like I had a severe case of the flu. It went away after 10 days, but came back again in two months and has been there ever since.”

Malott said the low-grade fevers were concerning to her doctors, as well as the hand pain, cardiac irregularities and low potassium.

“I noticed a decline in my short-term memory and my ability to concentrate at work,” she said. “I also developed severe insomnia, making it difficult to function day to day. I lost 60 pounds in about four months, which was another baffling piece.  this was a real telltale sign that something was wrong, as I have fought the battle of the bulge most of my adult life.”

Malott visited a rheumatologist at Johns Hopkins University Hospital in 2007, who was the first to tell her she might have CFS and/or fibromyalgia, a syndrome also associated with fatigue and muscle pain.

While mid-year crime statistics are down 29 percent, compared to the same time period last year, one category of cases has steadily and significantly escalated in Fallbrook over the past three years. Frequently referred to as “5150s,” these cases involve individuals displaying signs of a mental disorder and come under the Section 5150 of the California Welfare and Institutions Code. in 2009, local deputies handled 85 of these cases, and in 2010, 134. with 79 in the first six months of 2011, this year is currently on pace for 158.

“I?m looking into the causes of this upswing,” said Lt. RobertHaley, commander of the Fallbrook Sheriff?s substation. “There are many reasons a person can be having problems like this with the economy down as it is; people are out of work, losing their homes; and many are experiencing severe anxiety and depression.”

Haley said when his deputies respond to a potential 5150 call, the first priority is to determine whether or not the individual appears to be a threat to themselves or others.

“We have to do an assessment,” he said. “We observe the individual?s physical appearance, see if they are clothed appropriately, try to determine if they have been eating properly, and ask them a series of questions, including if they usually take medication or not. We have to be incredibly cautious, because mental illness is a disease and sometimes people don?t know what they are doing.”

While calls have come in to the station regarding individuals seen out in public talking to themselves, Haley said, “Just talking to yourself doesn?t qualify [as a 5150]. further evaluation has to be done.”

According to the Journal of the American Medical Association, approximately 50 percent of people with severe mental disorders are affected by substance abuse. Haley said the effects of illegal drugs are very evident to law enforcement officers.

“Meth [methamphetamine] is probably the worst [in causing mental problems] from my observation, followed by other stimulants [such as cocaine and ecstasy],” Haley said, adding a disclaimer that he is not a physician and has not conducted any studies on the subject. Haley does, however, have 25 years of law enforcement experience in a culture that is no stranger to drug abuse.

Drug abuse and its resulting effect on the brain have been tracked by mental health agencies. According to the National Drug Intelligence Center, some serious mental disorders associated with chronic drug abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), anxiety and panic disorders, obsessive-compulsive disorder, and more.

Professionals that provide counseling to individuals afflicted with drug-related mental health issues know only too well the negative effects these chemicals produce.

Marilyn Davies, a licensed marriage and family therapist with offices in Fallbrook and Temecula, has worked with patients in drug rehabilitation programs in the past.

“Those that have used meth, heroin, or crack for extended periods of time just aren?t thinking straight anymore,” said Davies. “It?s a very sad situation.”

Today, Davies focuses primarily on the wellbeing of families, and alcohol and substance abuse involvement presents itself frequently.

“The other issue that comes up with drug abuse is the destruction of family units; drug use is so damaging in so many ways; it affects all the family members because they are stressed out over the substance abuser,” explained Davies.

In many cases, experts have said it?s difficult to determine what came first – the mental disorder or the abuse of drugs.

Some individuals with mental illness take un-prescribed or illegal drugs to alleviate their symptoms – a practice known as self-medicating. One example would be a schizophrenic who uses marijuana in an attempt to control the disorder?s negative symptoms and calm them.

In other cases, mental disorders result from drug abuse. an example of this would be the use of the illegal drug known as ecstasy, which produces long-term reduction in serotonin function in the brain, leading to mental disorders such as depression and anxiety.

In handling some cases, deputies request assistance from the County of San Diego?s mobile Psychiatric Emergency Response Team (PERT), a non-profit organization that operates under the Community Research Foundation and is funded 100 percent by the County?s Health & Human Services Agency.

Developed to provide training and professional support to law enforcement in dealing with individuals with mental afflictions, PERT has 23 licensed clinicians throughout the county.

“Our licensed mental health professionals are dispersed throughout San Diego County; they work alongside uniformed law enforcement officers to respond to mental health crisis calls,” explained Jim Fix, executive director of PERT and a licensed clinical psychologist. when deputies encounter situations involving the mentally ill and feel they need assistance, Fix said, they radio their dispatch and request the closest PERT unit to respond. if one is not immediately available, help is still accessible.

“If there isn?t a team available close by, deputies have the ability to discuss the situation by radio or cell phone and being walked through the situation by one of our mental health professionals,” said Fix. “We try to always provide them with guidance and support.”

PERT clinicians make assessments and provide appropriate referrals and recommendations, with the goal of getting the person the treatment they need and averting further crisis.

Law enforcement officers regularly use the PERT resource and find it valuable.

“PERT is one of the best programs we have in law enforcement to utilize to help people with mental illness – not to just put someone in jail, but a door to open to help a person,” said Captain Gigi McCalla, commander of the Sheriff?s Dept. Lemon Grove station.

For those cases warranting it, Section 5150 permits an officer to involuntarily transport a person to an appropriate facility for up to 72 hours of mental evaluation.

Those taken into custody by Fallbrook deputies are generally taken to either Palomar Medical Center in Escondido or Tri City Hospital in Oceanside, both of which have secure evaluation facilities.

“Deputies take the individual to the emergency room to be admitted,” said Fix. “Then the emergency room staff evaluates whether the person should be admitted for 72 hours. Psychiatric liaisons evaluate the situation and consult with the patient; then they usually speak with the psychiatrist on call. if needed, the individual is admitted to the hospital?s behavioral health unit or one at another facility, or provided with referrals. The hospital makes the decision at that point.”

For members of the public, it can be disconcerting to encounter someone who is exhibiting signs of mental problems.

“If you encounter a person demonstrating some extreme behaviors, it?s best to keep a safe distance; back away; and go to an area where more people are located and get someone to call the Sheriff?s Dept.,” said John McLelland, crime prevention specialist for the Sheriff?s Dept. “I always tell people, when in doubt, call the cops and let them make a determination on the situation.”

Above all, Haley said, his deputies try to do their best to help those experiencing problems.

“We try to treat people with dignity and respect; sometimes they just need medical help,” he said.

When asked if Fallbrook appears to be unique in experiencing an increasing number of these cases, Haley said, “Fallbrook is just a reflection on today?s society in general.” Fix agreed.

“Other agencies are experiencing increases in these cases as well,” said Fix. “This phenomenon isn?t local to Fallbrook, it?s increasing everywhere.”

Source: all-breaking-news.com

But when she finishes residency this summer, Dr. Dewar, 31, will not be going home. Instead, she will take a job as a salaried emergency room doctor at a hospital in Elmira, N.Y., two hours away. an important reason is that she prefers the fast pace and interesting puzzles of emergency medicine, but another reason is that on Feb. 7 she gave birth to twins, and she cannot imagine raising them while working as hard as her father did.

My father tried really hard to get home, but work always got in the way, Dr. Dewar said. even on Christmas morning, we would have to wait to open our presents until Dad was done rounding at the hospital.

Dr. Dewars change of heart demonstrates the significant changes in American medicine that are transforming the way patients get care.

For decades, medicine has been dominated by fiercely independent doctors who owned their practices, worked night and day, had comfortable incomes and rarely saw their families.

But with two babies, Dr. Dewar wants a life different from her fathers and grandfathers. so instead of being an entrepreneur, she will become an employee of a large corporation working 36 hours a week half the hours her father and grandfather worked.

Indeed, emergency room and critical-care doctors work fewer hours than any other specialty, according to a 2008 report from the federal Department of Health and Human Services.

Her decision is part of a sweeping cultural overhaul of medicines traditional ethos that along with wrenching changes in its economics is transforming the profession. Like Dr. Dewar, many other young doctors are taking salaried jobs, working fewer hours, often going part time and even choosing specialties based on family reasons. the beepers and cellphones that once leashed doctors to their patients and practices on nights, weekends and holidays are being abandoned. Metaphorically, medicine has gone from being an individual to a team sport.

For doctors, the changes mean more control of their personal lives but less of their professional ones; for patients, care that is less personal but, as studies have shown, more proficient.

Older doctors view of these changes with considerable ambivalence, among them Dr. Dewars 90-year-old grandfather and 61-year-old father, although both supported Dr. Kate Dewars decisions and were thrilled about the birth of her twins.

My son and I had deeper feelings for our patients than I think Kate will ever have, Dr. William Dewar II said over lunch at a diner in Honesdale, about 30 miles northeast of Scranton. Munching on a club sandwich, Dr. William Dewar III gestured toward the diners owner, who had greeted them deferentially.

Ive had three generations of his family under my care, he said as a waitress brought his usual Diet Coke without being asked. Kate will never have that.

In a separate interview, Dr. Kate Dewar said that treating chronic conditions like diabetes and high cholesterol a huge part of her fathers daily life was not that interesting. she likened primary care to the movie Groundhog Day, in which the same boring problems recur endlessly. Needing constant stimulus she e-mails while watching TV she realized she could not practice the medicine of her forebears.

I like it when people get better, but Id rather it happen right in front of my eyes and not years later, she said. I like to fix stuff and then move on.

Her attitude is part of a gradual distancing between doctors and patients. Doctors were once revered, but a host of intermediaries insurers, lawyers, the Internet, growing patient needs and expectations have intervened, to the point that many patients now see doctors as interchangeable. Younger doctors are deciding that the personal price of being at their patients beck and call is too high, while acknowledging that teams of doctors can offer a higher quality of care. so they are embracing corporate, less entrepreneurial and less intimate roles in part for the uninterrupted family time they bring.

Look, Im as committed to being a doctor as anyone. I went back to work six weeks after my boys were born. I love my job, said Dr. Kate Dewar. but I was in tears walking out of the house that first day. Im the mother of twins, and I want to be there to feed them, play games with them or open presents with them on Christmas morning. or at least I want the option to do those things without fearing Ill be called back to the hospital.

The pain of that first weeks separation was lessened somewhat because she worked in the hospitals new pediatric emergency department. I felt better knowing that at least I was taking care of somebody elses babies even if I couldnt be with mine, she said.

Three Generations of M.D.s

The story of the Dewars demonstrates how these trends have played out over nearly seven decades.

Dr. William Dewar II opened his practice 67 years ago at his home in Catasauqua, Pa., an Allentown suburb, with his wife, Thelma, as his lone nurse and assistant. he delivered babies and set broken bones. Sick patients showed up on his doorstep at all hours, with some sleeping over. When they needed to be hospitalized, Dr. Dewar oversaw their care. Patients paid cash $2 for an office visit and $3 for a house call, fees that covered most needed medicines.

Thelma Dewar handled the bills and laboratory tests, often by cooking urine samples on the stove before analysis.

I loved my practice. Totally loved it, Dr. Dewar said. you were in touch with the patients. they were part of your family.

The culture of medicine at the time was decidedly macho. Residents routinely worked 120 hours a week, often staying at the hospital for days at a time. indeed, the term residency comes from the first such program at Johns Hopkins University, established around the start of the 20th century, where doctors lived in a dormitory next to the hospital, a monastic life inimical to women who wanted children. as the residency requirement took hold nationally, the share of female doctors, already low, fell further. Dr. William Osler, the founder of the residency program, celebrated such sacrifices.

What about the wife and babies if you have them? Leave them, Dr. Osler wrote. Heavy are the responsibilities to yourself, to the profession and to the public. your wife will be glad to bear her share of the sacrifices you make.

After 25 years in Catasauqua, the Dewars moved to the Honesdale area, and their oldest son joined the practice which by then had moved to an office building. but working outside the home meant that Dr. William Dewar III saw less of his children than his father had seen of his though he attended more of their sporting events. he tried to make a point of eating dinner with the family, but often failed because his sickest patients spent more time in the hospital as fewer people died at home. even when he did make it home for the meal, he often left afterward. he was on call seven days a week, limiting vacations.

We always joked that as soon as Dads butt hit the chair for dinner, his beeper would go off, Dr. Kate Dewar said.

A Changing Field

But even as the two men tried to keep their practice the same, the world around them kept shifting. their patients medical needs grew steadily, and specialists began to take over the more complicated procedures.

After his father retired at 75, Dr. Dewar merged his practice with those of four other doctors, eventually moving into a large building that once housed the towns bowling alley. Thousands of paper records occupy much of the buildings space, and 35 employees handle the billing and other clerical functions.

And the burden of trying to be all things to all of his patients became unmanageable. In 2006, after Wayne Memorial Hospital hired hospitalists doctors who specialize in taking care of hospitalized patients Dr. Dewar finally gave up hospital rounds.

For his hospitalized patients, the change meant putting their trust in a doctor who knew them less intimately but was more available and more adept at hospital care. My patients are getting better care now in the hospital, Dr. Dewar said.

And the change saved him hours of work each week. It meant getting off the hamster wheel, he said.

In her third year of medical school, Kate Dewar shadowed clinic doctors treating patients with everyday illnesses. It was just the kind of medicine her father practices: advising the obese to lose weight and the smokers to quit, and prescribing cholesterol and hypertension medicines again and again. I hated it, and I felt terribly guilty, she said. she called her father and broke the news that she wanted to work in a hospital. he was very supportive, she said.

Her father also remembered being both envious and disappointed. On the one hand, it bothers me that the generation of doctors that my daughter is in doesnt work as many hours and isnt willing to do the stuff that I did, he said. On the other hand, Im almost a little jealous.

Such mixed feelings are common among older doctors, many of whom have been unable to sell or even give away their practices because younger doctors are not willing to work the hours required. indeed, Dr. William Dewar IIIs practice has hired nurse practitioners recently, in part because it cannot recruit doctors.

Merritt Hawkins, a top doctor recruitment firm, reported that 51 percent of the positions it filled in the past year were for hospitals, up from 14 percent eight years ago. And even a growing share of the jobs the company filled in private practices included income guarantees from hospitals. Young doctors surveyed by Merritt Hawkins listed quality of life well above finances as the most important factor in their job searches, and just 1 percent said they were willing to practice alone. many young doctors will not take jobs that require them to be on call.

Almost every hospital in the country has vastly expanded its medical staff. Lehigh Valley Health Network in Allentown, where Dr. Kate Dewar currently works, has gone in seven years from 100 to 500 employed doctors.

A Different Pace

A day spent with Dr. Dewar in the emergency room of Lehigh Valley Hospital-Cedar Crest had the feel of an episode of E.R., far different from Marcus Welby, M.D., which her father grew up with. the attending physician was Dr. Rezarta Lloyd. the two women had complete control over a section of the emergency room reserved for the most serious cases, and there were many that day: a young woman with a deep gash on her hand that Dr. Dewar stitched closed, an older woman with suffocating fluid around her heart, and a 35-year-old man with a high fever, abdominal pains and an altered mental state.

The two doctors ordered a CT scan of the mans midsection, and they stood next to a computer terminal and toggled through images of his internal organs, deeply concerned.

Everything looks so inflamed, Dr. Dewar said as Dr. Lloyd nodded. look at the stomach. look at the wall there. What is wrong with this guy?

The more challenging the case, the better the women liked it. each tended to collect rare and difficult interventions like merit badges. Standing beside the display screen, Dr. Dewar told a story about having a patient whom she thought might need a tracheotomy, a rarely done procedure in which a tube is put into a patients throat to prevent suffocation. she had a trach kit placed in the patients room just in case.

While attending to another patient, Dr. Dewar noticed a commotion outside the patients room and yelled at her colleague on duty, playfully threatening bodily harm to anyone else daring to do her tracheotomy.

The tracheotomy story was interrupted by another phone call from one of the hospitals radiology technologists, whom Drs. Dewar and Lloyd had sparred with all day. the two had sent a patient whose damaged eye was bleeding, leaking fluid and bulging. the doctors had described the patients condition in the order they submitted for the CT scan, but the technologists rarely seemed to read those instructions closely, Dr. Dewar complained.

No, she said. Were looking for a globe rupture.

Then a 22-year-old man showed up with flu symptoms. Dr. Dewar, pregnant at the time, kept her distance while Dr. Lloyd went to his bedside and, later in the day, prescribed antivirals.

My big fear is patients with the flu, Dr. Dewar explained. Pregnant women were the ones who died from H1N1, so Dr. Lloyd protects me by seeing them herself. I had my flu shot and all that, but if I dont have to risk it, I wont.

Pregnant residents are another sign of medicines shifting culture. Residency hours and practices were once so grueling that few doctors deliberately became parents during those years. but in an effort to reduce fatigue-related errors, residency hours were reduced in 2003 to 80 per week. last year at Johns Hopkins, the birthplace of the residency program, more than a third of the women in one internal medicine residency program became pregnant or were the mothers of young children an outcome that would have been unimaginable to William Osler.

Still, carrying twins on a job that requires hours of walking between rooms was not easy. On a nine-hour shift in her 29th week, she drank three liters of water and snacked constantly on cheese crackers.

But when her shift ended, Dr. Dewar went home and put up her feet. And no pager threatened her rest something her father has rarely experienced.

“silent doctors don’t make sport!” thus I am obligated to share an experience with you.

On Sunday we arrived at St John’s Parish Church at 5:45 to commence the family’s morning walk. it was performed at an extremely blistering pace – down Pot House Hill, up Bath and Colleton Hill, and back to base.  

Unexpectedly, I was then invited to visit the burial site of the late Prime Minister David Thompson.

As I whispered a few words, my mind was again infused with these: “I tell you the truth, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there’ and it will move. nothing will be impossible for you.” (Matthew 17:20). As I was penning this article, light consciously “hovered” over me as wisdom began to unfold.

 let “silent doctor” mustard make your day as the light of the Creator blesses you. the yellow flowers which bloom on Brassica juncea display its healing capacity. it belongs to the Bassicaceae family. Mustard green is forgotten or faces extinction in Barbados, but we can save it.

I dedicate myself to encouraging people to share its seeds, to keep the species alive. In fact, last Saturday my neighbour refunded me with some seeds. I intend to have them blooming in my garden for Agrofest 2011.

Mustard leaves are very pungent and are excellent sources of Vitamin A, B1, B2 and B6, C and E, beta-carotene, folic acid, magnesium, copper, fibre, potassium, protein, calcium, iron and niacin. some people use it to treat asthma, sore throat, heart disease, menopausal symptoms, toothache, itching, external parasites, pyorrhea, epilepsy, colic, bladder inflammation and haemorrhage. Cancer prevention may also be considered.

Additionally, mustard seeds contain Omega 3 fatty acids, iron, manganese, zinc, protein, calcium, dietary fiber, magnesium, niacin, mono-unsaturated fats, phosphorous and zinc. In some cultures mustard seeds are used to treat paralysis, abscesses, bronchitis, colds, anorexia, snake bites, splenic disorders, rheumatism, ulcers, stomach disorders, symptoms associated with menopause including distorted sleep patterns, asthma, cancer, migraine attacks, high blood pressure, atherosclerosis and heart disease.

You can also do research on mustard plasters, which are still being used to successfully treat asthma, rheumatism, stiff neck, arthritis, chest congestion, aching backs and sore muscles. Mustard oil is used to treat damaged hair, dental infections and pneumonia. Mustard oil is more useful than its economical price and appearance suggest. I can assure you it has boosted my health.

As you eat the leaves, rub with the oil, use the seeds and powder, you can repeat: “I love and approve of myself, my health and healing.”

In conclusion, faith combined with a mustard seed is divine. Happy mustard planting!