Live Workshop 2

[dschwarz]

I am excited that I was able to reorganize my schedule to be able to make the meeting on Wednesday.

Some of the publication related to misdiagnosis of mind-body disorders such as Functional Neurological Disorders (FND)/conversion disorder as issues stemming from structural problems are interesting. (For context, I am a DPT/physio in the US working on my PhD) I had a patient who I could not convince the doctor to have better assessment performed on her. She had two strokes in a 4-5 years period with the first one triggering significant depression which improved in the 6-8 months prior to the seconds stroke, and the second stroke having episodes of dizziness that became problematic 2-3 months after the stroke. She became fearful and stopped walking due to the dizziness and falling. She had a particular movement pattern that appear with symptoms that included reduced reaction to environmental stimuli and rotating her head to one side. I was able to help her understand better the recongition of kinesiophobia related to dizziness/fatigue/pain and her symptoms initially resolved within a couple of days so we could progress improving her confidence with movement. At times throughout care these symptoms would return and I tried to get the doctors office to stop telling her it is all because of her stroke. Unfortunately, I was unsuccessful at that (I would like to think that I am typically successful with educating the physicians I have worked with, but pobody’s nerfect, right?). I have the way I learned for educating physicians and other healthcare professional on mind-body, FND/conversion, whole person problems, but are there any favorite ways that you all have?

The way I learned/taught myself: Typically, I describe the symptoms and the current assumed aetiology. I then describe what I see with movement and function and describe how these are not consistent with the current problem (or what parts are consistent and what are not). Then I describe the current context of stressors and some of the conversations I have had with the patient. Finally, suggesting that the condition appearred to be of a functional nature and describing how I came to that conclusion through testing such as cognitive initiation of sensory provcation (motor imagery, memory, imagined context changes), Hoover’s sign, hip abductor test, modulation of attention, etc. After all of that, I asking what questions, comments, or concerns they have.

Thanks!
David J Schwarz

[khughes]

HI Lilia
I often work with a similar population (hospice/palliative medicine). Not sure if you’ve already tried this, but some families like to use guided practices/recordings that they turn on for the patient to help them refocus /feel more safe/calm/relaxed when their symptoms are worse. (i tailor the practices to what has been helpful in sessions or what they have access to.- for some, self compassion practices such as Dr. Kristin Neff’s recordings on selfcompassion.org can be helpful- i don’t know if the recordings are available in Spanish language. For others, I recommend Insight Timer or other apps (usually the younger generation has to help with setting this up)-

[Lilia Graue, MD]

Hi Karin, thank you for bringing guided practices into the conversation. I’ve recorded guided practices in Spanish for my patients (mindfulness, self-compassion, somatic tracking, toggling back and forth between difficult sensations and pleasant/neutral sensations, and visualizations), and throughout our work together I’ve shared several with my patient, her family and professional caregivers (we would do them together in session and then I’d share a recording). It’s been hit and miss, to be honest; some days she’s willing to try and practice, most days she isn’t. In general, her motivation to engage with any kind of practice, including breath and movement, is very low. She does like massages, so we’ve brought in a massage therapist to see her twice a week, and her caregivers also regularly offer massages. Among the practices we’ve explored together, visualizations have been the most successful – she has a really hard time tuning into sensations and the self-compassion practices don’t really resonate with her. I like your suggestion to ask her caregivers to offer that option more often, and see how it goes.

Thank you for this, and I’d love to hear more about other practices that have been useful with the hospice/palliative medicine population you work with.

[hschubiner]

Thanks very much, David.
You’re doing a fantastic job! I would simply add that looking carefully for the FIT criteria and doing provocative/neural circuit testing can be very helpful in
helping people with the actual clinical evidence that these are mind-body conditions. We will be covering those in upcoming months in the live class; and they are part of the OVID mobile app as well.
Best, Howard

[khughes]

hi Lilia
YOu are providing such comprehensive wrap around care of your patient and family! Just your attention/care to all those details I’m sure is making a big difference. I think managing our own expectations is important and reassessing their goals of the “therapy/treatment” in this population particularly.-
The only other things i can think of would be: 1- the more we can support the family to feel calm/regulated around their loved one, that seems to be very therapeutic for these individuals and the family unit. Sometimes I/we end up working primarily with the family members to be more regulated and that can make all the difference for the patient. 2- Helping to teach the patient the skill of “savoring”(5 senses or a view, awe, etc), “Taking in the good” and staying with neutral or positive sensations in the body for 10-15 seconds at a time also has been very effective for one of my patient’s with cognitive decline. (RIck Hanson, PhD’s work primarily but also from Post Traumatic Growth Somatic therapy/mindfulness based somatic therapy). If they can learn to stay with positive sensations/experiences or if the family can direct them to stay with experiences longer, I find the nervous system gets more regulated/more safety is felt in the body/mind and the danger alarm is turned down. If you want to discuss more please email me karinleehughes@me.com. happy to explore more thanks Karin

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