Am I Experiencing Vicarious Trauma?

Authors: Jennifer Hughes, PhD, and Alisha Bowker, LCSW, UMC Trauma Recovery Clinic Team

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At times it can feel nearly impossible to find the motivation to keep showing up to work, week after week, especially after working long hours or dealing with crises and looming deadlines. Working in the medical and helping fields, especially, we are often overwhelmed with horrific stories of violence, pain and trauma, which can dramatically alter the way in which we understand the world, ourselves and others.

The clinical term for this phenomena is Vicarious Trauma (VT).

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What is Vicarious Trauma (VT)?

Vicarious Trauma can be defined as a change in a helper’s inner experiences after working with people who have experienced traumatic events. Trauma can be defined as a deeply or distressing event that one directly witnesses or hears about. This can include natural disasters, interpersonal violence, war, divorce, childhood abuse and so on.

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Does Everyone Experience VT?

VT is a natural consequence of being an empathetic human, and being exposed to a population who has experienced trauma. Those often impacted by VT are social workers, case managers, doctors, nurses, first responders, etc. It is an inevitable hazard in these lines of work and, unfortunately, cannot be avoided, but definitely can be addressed and managed.

VT can also extend not only to helping professionals who work with this population, but also to the caregivers or loved ones of a survivor.

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How Does VT Impact My Life?

Vicarious Trauma is an ongoing process that slowly builds over time the longer we are exposed to the stories of trauma survivors. It generally begins to impact us in three different realms:

  1. Identity: It begins to impact our identity, which changes the way we see and define ourselves.
  2. Worldview: It impacts our worldview by skewing the ways in which we understand others or understand how to interact with those around us.
  3. Spirituality: It can impact our spirituality, and replace feelings of hope with feelings of cynicism and despair.

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VT Versus Burnout

Vicarious Trauma is different than burnout, as it truly only develops after being exposed to traumatic stories. Burnout is a state of chronic stress, particularly in a work environment, that leads to physical and emotional exhaustion, cynicism, detachment and feelings of worthlessness.

While the symptoms are similar, burnout is generally not rooted in trauma exposure.

Signs and Symptoms of VT

Some of the most common signs and symptoms of VT fall under these 5 areas:

  1. Cognitive: Intrusive thoughts, sounds or images about the traumas an individual has been exposed to, difficulty concentrating, constantly thinking about survivors outside of work, becoming more cynical or negative in one’s thinking patterns.
  2. Physiological: Ulcers, headaches, chronic pain, stomach aches, sweating or heart racing when reminded of a trauma
  3. Spiritual: Lose hope, see others as bad or evil and lose sight of the good in humanity, difficulty trusting our own beliefs
  4. Behavioral: Hair trigger temper, isolating, using unhelpful coping to manage big feelings (drinking, drugging, gambling), need to control everything and everyone
  5. Emotional: Lose touch with one’s own self-worth, isolate from loved ones, feeling overwhelmed or emotionally restricted

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So now that we have the language to define the symptoms we are experiencing, what can we do about it?

Thankfully there is an answer for this and it can be broken down into three phases:

Anticipate and Protect, Address and Transform

  1. Anticipate and Protect: Arrange things ahead of time to anticipate the stress of your work and its impact on you.
    • Become aware of VT and start to look out for signs and symptoms. Intentionally plan for a healthy balance between your work life and personal life.
    • Find a support system, particularly amongst colleagues who share this language and can support you as needed.
  2. Address: How you take care of yourself in and out of work
    • Engage in Self-care: Attending to yourself physically, spiritually, emotionally and psychologically
    • Self-nurture: Engaging in activities or things that provide comfort, relaxation and play
    • Escape: Getting away (whether literally or mentally)
  3. Transform: Transform the negative aspects of this work into positive connection and meaning
    • Create Meaning: Find ways to hold onto your values and identify even in the face of trauma
    • Infuse current activities with new meaning: Mindfulness, Connection to others
    • Challenge negative beliefs: Actively challenge negative thoughts or cynicism/ Re-frame your thinking

While vicarious trauma is a very common and inevitable consequence to the work that we do, the exciting news is that we have the tools to fight back. This is an ongoing process that will continue to look different at different stages of our careers, so it is a process we must continuously be engaging with.

Both individually and collaboratively, begin to identify the signs of VT in your own life and use the template above to make a plan for how to begin addressing and counteracting these symptoms.

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Remember, you are not alone with your vicarious trauma, and do not have to manage it alone either.  

Know Your Numbers

Authors: Alan Gatz, MD and Kendria Holt-Rogers, MD, UMC Primary Care Physicians

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Today,  many people are aware of the need to focus on the effect of risk factors and life choices on overall health and wellness. Health professionals speak to patients about cholesterol, blood sugar, blood pressure, BMI (body-mass index), and hemoglobin A1c, but many individuals become overwhelmed and do not totally understand all of the information as presented.

Here’s a condensed and simplified description of the above mentioned health determinants.

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Cholesterol

This term actually should be changed to lipids, which includes the entire family of proteins sub-divided into three major subcategories:

  1. LDL (low density lipoprotein) cholesterol
  2. HDL (high-density lipoprotein) cholesterol, and
  3. Triglycerides (TG).

The two numbers the majority of people need to remember are their LDL and HDL levels.

A simple way to understand the concept of reducing heart and vascular disease is to keep the low low and the high high. LDL level above 150 mg% increases the risk of developing blood vessel blockage while HDL above 50 mg% helps protect against the development of this problem.

High triglycerides also can affect a person’s health including development of pancreatic disease.  Any intervention – including lifestyle changes and medications –  that will improve the overall cholesterol readings will also improve the total TG.

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Interventions to improve the cholesterol numbers and reduce risk of cardiac disease:

  • Exercise – 30-45 minutes 3 times per week
  • Diet – increase fiber, reduce fat and sugar
  • Weight loss – even 5 pounds will affect the level
  • Medication – effective but comes with risk of side effects

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Blood sugar (Glucose)

Important in the proper functioning of most all body systems, if the blood level is too high, many of the major organs can be damaged irrevocably, most notably the heart, kidneys, circulatory system and eyes. Normally, people think of getting a blood sugar reading by having their finger lanced to obtain a drop of blood.  This “spot” reading will give an idea of current glucose level but the Hemoglobin A1c (Hgb A1c) is much better at allowing us to determine average blood sugar level over several weeks.

Without getting too scientific, the higher the average blood sugar, the higher the level of Hgb A1c.  In general we strive to get the level below 7%.

Ways to improve Hgb A1c :

  • Take your medications as prescribed
  • Prescribed exercise program
  • Improve diet and control your weight

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Body Mass Index

This number is determined by a patient’s height and weight.

The ideal BMI is between 18.5 and 25.  Below 18.5 is considered underweight with 25-30 being overweight.

Those individuals above 30 are classified obese.  The importance of BMI lies with the effects of stress on the heart, circulatory system, joints, muscles and metabolism.  Severe obesity with BMI greater than 36 increases the individual’s risk for hypertension, myocardial infarction (heart attack), stroke, diabetes, degenerative arthritis, decreased independence.  Obviously we cannot affect the BMI by growing taller but anything we can do to reduce weight will improve the BMI.

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Blood Pressure

The measurement of blood pressure is important in determining the stress the heart experiences pumping the blood through the thousands (approximately 60K) of miles of blood vessels in the body. Like a body builder the heart, if faced with greater weight (pressure), will grow to meet the challenge.  But, also like the body builder, there can be too much growth (the heart becomes muscle bound) which results in the heart failing to “lift the weight”. The result is heart failure which many times causes permanent disability and death. 

We don’t have the time or space to discuss the effects of blood pressure on the kidneys,  but suffice it to say untreated blood pressure is a leading cause of kidney failure and need for dialysis.

Remember these numbers – Systolic 135, Diastolic 80. 

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If your readings fall above these numbers you should seriously consider speaking with your health care provider about intervention.

Interventions to improve blood pressure:

  • Reduce weight
  • Reduce alcohol intake
  • Reduce salt in the diet
  • Exercise with emphasis on aerobic activity
  • Adequate rest – sleep 6-8 hours/night
  • Stress reduction – yoga, meditation, therapeutic massage

Hopefully, this primer will help you manage your health with greater confidence and purpose.

Dr. Gatz and Dr. Rogers look forward to being your partner in wellness. To schedule an appointment, call the clinic at 504-962-6120. Visit www.umcno.org/primary-care to learn more about UMC’s Primary Care Center and its services.

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Colon Cancer: When & Why You Should Start Screening

Author: Guy Orangio, MD,  FACS, FASCRS, UMC Colorectal Cancer Surgeon

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Colorectal cancer is the fourth most commonly occurring cancer and the second leading cause of cancer deaths in the United States, with over 56,000 people expected to die from this disease each year. However, this cancer is preventable and curable when detected and treated early.

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March is Colorectal Cancer Awareness Month, a perfect time to learn more about  this disease and when and why to get screened. Because there are often no symptoms when it is first developing, colorectal cancer can only be caught early through regular screening.

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Most colon cancers start as non-cancerous growths called polyps. If we are able to find these polyps while they are still non-cancerous, we remove them and the cancer may be prevented. Major surgery can usually be avoided.

STAGES

Screening programs begin by classification of risk based on personal, family and medical history. People who are at increased risk may need earlier and more frequent screening depending upon the recommendation of their healthcare provider.

The American Society of Colon and Rectal Surgeons (ASCRS), which is dedicated to advancing the treatment of patients with diseases affecting the colon, rectum and anus, supports the following colorectal cancer screening guidelines:

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Recommendations Screening People at Average Risk

  • Men and women at average risk should have screening for colorectal cancer and adenomatous polyps beginning at age 50 years.
  • A colonoscopy (a test that allows the physician to look directly at the lining of the entire colon and rectum) every 10 years or a barium enema (x-ray of the colon) every 5 to 10 years are acceptable alternatives. •

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Recommendations for Screening People at Increased Risk

  • People at increased risk of colorectal cancer or adenomatous polyps include those with first-degree relative (parent, sibling or child) with colon cancer or adenomatous polyps diagnosed before 60 years
  • People with two first-degree relatives who were diagnosed at any age, should have screening colonoscopy starting at age 40 years — or ten years younger than the earliest diagnosis in their family — and then repeat every five years.
  • People with a first-degree relative with colon cancer or adenomatous polyp diagnosed at age greater than 60 years or two second degree relatives with colorectal cancer should be advised to be screened as average risk persons beginning at age 40 years
  • People with one second-degree relative (grandparent, aunt or uncle) or a third-degree relative (great-grandparent or cousin) with colorectal cancer should be screened as average risk persons

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Prevention Tips

In addition to timely and regular screening for colorectal cancer, people may be able to lower their risk of getting the disease by:

  • Avoiding foods that are high in fat.
  • Eating plenty of vegetables, fruits and other high-fiber foods.
  • Exercising regularly and maintaining a normal body weight.
  • Not smoking and drinking alcohol only in moderation.

 

For information on the Comprehensive Colorectal Cancer Program at UMC, click here.

 

About Dr. Orangio

Guy Orangio

Guy Orangio, MD, is a board-certified colorectal surgeon at UMC and an Association Professor of Clinical Surgery at LSU Health New Orleans.

 

The ABC’s of Antibiotics

Author: Jennifer Lambert, PharmD, MPA, UMCNO Clinical Pharmacist

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What are Antibiotics?

Antibiotics are types of medicine that help stop infections caused by bacteria. How they do this is by (1) killing the bacteria or (2) keeping the bacteria from reproducing.

The word antibiotic, itself, means “against life.”

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Did You Know?

An estimated 2 million illnesses and 23,000 deaths occur each year in the US due to antibiotic resistant infections.1 Antibiotics are drugs used to treat bacterial infections, not viral infections. Using antibiotics the wrong way can lead to antibiotic-resistant infections that cause illness or death. This is why healthcare providers are being more careful when prescribing antibiotics.

  • When not used correctly, antibiotics can be harmful to your health.
  • Antibiotics can cure most bacterial infections. Antibiotics cannot cure viral illnesses.
  • Antibiotics cause one out of five Emergency Department visits for drug-related side effects.
  • It is estimated that more than half of antibiotics are unnecessarily prescribed.1
  • Antibiotics can lead to severe forms of diarrhea that can be life- threatening, especially in elderly patients.
  • When you are sick, antibiotics are not always the answer

Antibiotics: The Alphabet Letter by Letter

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A (Ask)

  • “Are these antibiotics necessary?” and “What can I do to feel better?”

B (Bacteria)

  • Antibiotics do not kill viruses. They only kill bacteria.

C (Complete the Course)

  • Take all of your antibiotics exactly as prescribed (even if you are feeling better).

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How Can You Help Prevent Antibiotic Resistance?

  • Take antibiotics exactly as your healthcare provider instructs.
  • Only take antibiotics prescribed for you.
  • Do not save antibiotics for the next illness or share them with others.
  • Do not pressure your healthcare provider for antibiotics.

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Do You Need an Antibiotic?

Illness Virus Bacteria
Colds NO
Flu NO
Whooping cough YES
Strep throat YES
Most ear aches NO
Bronchitis NO
Pneumonia YES

What Can You Do to Help Yourself Feel Better if You Have a Viral Illness?

Pain relievers, fever reducers, decongestants, saline nasal spray or drops, warm compresses, liquids, and rest may be the best things to help you feel better. Ask your healthcare provider or pharmacist what symptom relief is best for you.

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Prescriptions for antibiotics can be filled and picked up at the Walgreens Pharmacy at UMC.

 

If you are in need of a healthcare provider, click here.

 

Citations:

1 CDC. Antibiotic Resistance Threats in the United States, 2013. 16 September 2013. 32.

Be Mindful, B-WELL

Authors: Jennifer Hughes, Ph.D. (UMC Trauma Psychologist), Alisha Bowker (UMC Licensed Clinical Social Worker)iStock-639641818 (1).jpg

Mindfulness is defined as a mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations.

Do you feel burnt out? Are you overworked? Do you feel as though you are at a crossroads in life? Are you happy?

Practicing mindfulness can help anyone who experiences stress, feels overwhelmed or battles with despair. It is proven to help many patients, too – especially those who have experienced trauma — learn how to cope with physical and emotional pain.

It also benefits healthcare professionals as they cope with stress after providing care to others, connect with patients, and work improve their quality of life.

For mental health professionals, this awareness helps reduce negative emotions and anxiety, and increases their positive emotions and feelings of self-compassion.

Research through Harvard University, the National Institutes of Health, and other leading healthcare agencies have shown that mindfulness can be effective, additionally, in reducing stress, symptoms of anxiety and depression, and improving sleep and pain management.
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Starting a mindfulness practice can be as simple as following these steps:

  • Choose a specific time: Set aside a time and space each day to practice mindfulness. It can be the same time everyday or different times, whatever is best for you. Find a quiet place with few distractions and take a comfortable seat in a chair or on a pillow on the floor.
  • Observe the here and now: The goal of a mindfulness practice is not to quiet the mind; in fact, our mind is made to wander, so why fight its natural instincts! Instead, set the intention of paying attention to the present, the here and now, without judgment.
  • Allow your judgments to come and go: When your mind inevitably begins to wander, some of those thoughts may be judging the current situation (for better or worse). When these thoughts arise, make a mental note of their presence and let them pass, and return back to the here and now. Don’t get bogged down in the power of judgment!
  • Be kind to your wandering mind: When we practice mindfulness, it can be helpful to begin by welcoming all of ourselves, including our pesky wandering mind. When your mind begins to drift away from the present moment, don’t judge it or yourself. Practice noticing those thoughts and returning to the here and now. Welcome your mind just as it is. iStock-584608574.jpg

 Mindfulness can also help with:

  • Physical Pain: One of the most effective mindfulness practices to help ease physical pain is the body scan, which allows us to identify and “dive into” different body sensations. By first focusing on specific body sensations and then widening our awareness to our body as a whole can help us to identify less with our pain.
  • Stress, Anxiety/Trauma, and Depression:
    • Stress: mindfulness can reduce stress in the moment and give you skills that will help decrease the impact of stress in the future
    • Anxiety and Trauma: Mindfulness can help the brain respond to traumatic memories in less painful and more helpful ways. This helps reduce the negative impact of traumatic events and improve overall functioning
    • Depression: Mindfulness can help ease the symptoms of depression by decreasing the cycle of negative thought patterns, feelings, and behaviors. It can even help to improve relationships with others through breaking these cycles

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At University Medical Center New Orleans, we are working to address burnout and compassion fatigue by focusing on mindfulness and other wellness initiatives through B-WELL: a new program that aims to give back to our employees and encourage them to remember to take care of themselves.

Our advice to you?: Be mindful to work toward B(ing)-WELL.

For more information on mindfulness, check out these resources:

Online

Books

  • Full Catastrophe Living by Jon Kabat-Zinn
  • A Mindfulness-Based Stress Reduction Workbook by Bob Stahl, Ph.D. and Elisha Goldstein, Ph.D.

Free Smartphone Apps

  • Stop, Breathe & Think
  • Insight Timer
  • PTSD Coach
  • Mindfulness Coach
  • Headspace (Paid)