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Painful Past: Medical Effects and Eternal Opportunities

Melinda Skau MD

Presenter

Melinda Skau MD

Medical Director, Feather River Tribal Health in Oroville, California

Conference

Recorded

  • October 26, 2018
    2:00 PM
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Lord we are so thankful to be here this week and thankful for the way that your word is spoken and song and resoundingly our hearts we especially asked read a prayer your spirit pour out your spirit I'm in this hour that we have together Lord help us to see how we can use this as a tool to help our patients reach you and help us to see how glorious You are in pouring out your healing and we just we just missed him this time with you so Lord I'm opening my mouth I really want you to feel it with your words so that you can be seen in the name of Jesus. So our title is painful past medical effects and internal opportunities. It's really about the adverse childhood experience score how many of you are familiar with a study that was done from 95 to 97 by Vincent already at Kaiser anybody familiar with the study. So I was actually working Kaiser I did my residency at Kaiser Family Practice from 1982 to 1985 and while I was there toward the end of the eighty's and into the ninety's Vincent he was running a very comprehensive program for weight management and then patients were losing up to $300.00 pounds in a year on this program it was it was complicated program they had dieticians an exercise in counseling groups and private counseling and dance therapy are all kinds of stuff and it was a very successful program but something puzzled Dr 40 and that was that he would have patients his most successful patients that would suddenly start gaining all the weight back faster than he thought physiologically possible so this stumped him and he went to the source to ask why and he interviewed those patients that suddenly start to gain their weight back and what he heard were stories about childhood as verse experiences so he I remember one that he told it was a lady that had gone out dancing with her husband and somebody had cut him and the person that cut in reminded her of someone who had sexually abused her as a child and then she immediately put on all this weight what what Dr Phil that he found out was that what we physicians perceive as the problem the city was actually the patients perceive solution to vulnerability susceptibility to assault. That was a nice innertube around the. Little it kept people at a distance made them feel safer. Same reason why people might smoke up a cloud of smoke so that people stayed further away from them. Anyway he said what we providers think is the problem is actually patients perceive solution and they were using especially carbs to push down the feelings that were coming up bereavement shame regret guilt feelings from a child and I remember he told one story about a young man who had watched his brother crash a go cart into a cement wall and he had this in the back of his childhood and when some of that happened at the end of his successful weight management program that reminded him he immediately start eating eating for comfort so Dr Phil he said let's let's study this and of course Kaiser makes a beautiful place to study patients because they had all these charts they could follow for 20 plus years and see what these traumas in childhood what these patients ended up having for medical effects 20 years down the line so this is the quiz that they gave there's some on the table if you don't have women and get you a copy of it the quiz that they gave asked just 10 questions and it's it was have you been abused physically emotionally or sexually Have you been neglected under age 18 that is physical or emotional neglect so physical neglect maybe you didn't have anybody to give you enough food before you went to school or didn't have the right clothes to wear to school and nobody's washing your clothes you came home to an empty household. Emotional legal act you might have a parent to is very very ill with cancer or who is on drugs and can't pay attention to you so your emotion in collected household dysfunctions or on the quickness mental illness and apparent that could be bipolar depression or any other mental illness you might have a relative who was incarcerated. Or a mother who was treated by a lonely since this quiz they've actually had either parent who was treated violently. Substance Abuse of any kind and divorced of your parents so those with a 10 things that they asked questions about so our object is today we're talking about what are the adverse child experiences with we just saw and what's the impact of Ace's on physical health in adulthood. And how can we fill Cilla take communication with their patients about their adverse childhood experiences and why should we even have those conversations when I brought it up to my provider that I wanted to implement this the medical director for the river tribal hell and I brought it up at a staff meeting and I really wanted to have these quizzes in each exam room and ask patients these questions my private Oh shock you want to ask those person I mean it's pretty explicit on there and I said Well as said what Dr politically says is that just giving the patient the quiz having them fill out yes or no you don't even have to know which ones are yes or no having them fill it out tell you their score and tell you how they think those things are impacting their current health very simple takes about 3 minutes in the office just that reduces their symptoms scores of whatever illness it is they're struggling with by about 30 percent in fact he said that even Uni took patients and. Had them fill out the quiz and told them to just think about what the impact was on their current health and put it in a locked box with the promise that a compassionate provider would read it he still got the 30 percent decrease and some scores so just the act of doing it was helpful so that's why we had a conversation so who participated in adverse childhood experiences study since it was done at Kaiser It was a primarily working population about 30 percent men and women and age 46 percent of the patients were over age 60 and another almost 40 percent were in the 40 to 60 range. Mostly white about 75 percent white percent Hispanic 7 percent agent and then a mix of the few left education of the patients that took this quiz 75 percent had either some college all college or post college degree so this is a fairly educated community I wonder how this study would have come out if it had been done where I grew up near Los Angeles and the gang neighborhood. So how common are the adverse childhood experiences only 36 percent of patients can remember none of those experiences and 74 percent of patients have at least $112.00 and a half percent of the patients have 4 or more and this is significant we'll see later on in some of the illnesses so they're common 28 percent of the patients interviewed reported physical abuse 21 percent reported sexual abuse and more than one in 5 of those patients reported sexual abuse and they cluster if you have one you are likely that you might have more than one and you know it's pretty amazing that actually one in 8 people have 4 more on their on their scale and the mazing thing is that these cases have a dose response curve to disease so the more aces you have the higher your risk of many diseases will go over some of those. So I don't know if you can read the small print in the back but but the adverse trial had experiences on the bottom tier of this pyramid the next pure next block up is disrupted neuro development so we think that these very stressful childhood experiences cause a huge outrage of cortisol So 1st the child is exposed to the adrenaline that comes and you know the flight or fight mechanism is great if you're fighting off a bear or a lion or running away but if it's every night and daddy is the alcoholic bear it becomes very taxing on the child's system and so then they develop disruption of their social emotional and cognitive impairment we recently had a young mother and her 2 children staying with us for about 9 months and when the 2 year old 1st came to stay with us I truly thought he was autistic he could not respond. Very well to his language and social development physical development were very delayed and it was because he had been in the household with a very abusive father and so after 9 months of staying with us he really blossomed he was getting therapy in the home and and he had a relaxed environment and his language skills were catching up to a normal 3 year old was starting to laugh and play happily a lot of the negative behaviors were extinct. So what happens is that these children who have social emotional and cognitive impairment may adopt high risk health behaviors that is use of alcohol drugs high risk sex and then they get diseases disability and social problems from that and early death. So we see that if you have 7 or more 6 more or 6 more races you die 20 years early on average than the people with out aces That's a lot when years I mean when we see something like that in heart disease or cancer or other things we do something about it but for a long time we've been kind of quiet about adverse childhood traumas So back to this this view I just want to remind you this the temp things we're looking at are physical emotional and sexual abuse physical and emotional neglect and household dysfunctions like mental illness parent treated by a lonely divorce incarceration and substance abuse. So I want to tell you about a case history that Dr Allison Jackson did in a TED talk Haven't you heard of Dr Allison Jackson if you have a chance to google her TED talk it's very good she talks about Harry who at age 6 weeks of age of the neighborhood watch volunteer heard screaming coming from a drunk parent and her his house and he was squabbling too but they looked at themselves and said oh you know our real job is to keep houses from a broken into we're getting broken into we're not going to do anything about that so they kind of ignored that incident at age 2 a preschool teacher noted that Harry's mom had a black eye and perhaps there were some fading bruises on Harry too but again no one did anything about it because they were in the job of running a preschool in the they were mandated reporters and should have done something about it. At age 5 there was a major event and Harry's life he came downstairs one morning to find his mother lying with blood on the floor of the kitchen his father standing angrily above her and policeman broke down the. Door and took his father off to jail his mother was taken to the hospital hairiest put in a squad car and heard a tapping at the window from a foster care person saying gather your things in a bag I'm taking you into a foster care situation and after that her he was in 12 different foster homes over his growing up years because he was a difficult child you can imagine he was angry he was confused he didn't do well at school he had a huge file at school and a huge file with the foster care system nobody wanted to drop this difficult child. At age 14 her he was in a foster home where the foster father was angry with the foster mother and Harry thought he was going to hurt her and Harry thought this this flash of anger from his childhood seeing his mom go through that situation just flashed up and Harry and he slugged the foster dad and was immediately put into detention. So we see these kind of Harrys in our practice we may see them with hypertension and morbid obesity and alcohol use disorder and tobacco use disorder and C O P D in their adulthood so we see the end products of of the addictions and poor health behaviors that develop when a child comes through the system so by age 42 Harry may have a have type 2 diabetes from his obesity and alcohol use that name may then get us to me my cardio infarction and by age 62 that he may have a stroke this is what we see early death so if you actually look at Harry's. Let's go back to that Harry is a score how high do you think is a score what we can total it up he would have had physical abuse emotional abuse probably some physical neglect when he was in the home with the alcoholic father definitely some emotion on the glass people weren't connecting with him at school or in the foster home mental illness in his household a mother that was treated violently his parents did split up. Carcinoid relative a father who was using substance so his score may have been as high as 8 or 9. So when we see children that goes through these traumas we oftentimes seen a baby hey viewers in their adulthood such as lack of physical activity they may be afraid even to go outside they may have social disorders but when. We see smoking we see alcoholism drug use mix missed work absenteeism and then we see physical and mental health consequences like severe obesity diabetes depression suicide attempts S.T.D. hard disease cancer stroke C O P T and broken bones so let's just look at some of these factors in a little more detail as far as alcohol goes the 1st alcohol use by age 14 was increased 2 to 3 times in patients with a high score Ace's a talented for 20 to 70 percent increased likelihood of alcohol use initiated during mid out of lessons and the total number of aces had a very strong graded relationship to initiating alcohol during early adolescence with drug use each case increased the likelihood of early drug use by 2 to 4 times each one by 2 to 4 times and compare with people who had no basis people with equal to or more than 5 aces were 7 to 10 times more likely to report illicit drug use so what about obesity the 2 factors a aces that were most associated with obesity were physical abuse and verbal abuse and compared with patients who had no physical abuse those who reported being often hit or injured had a 4 kilo higher rate and a $1.00 relative risk odds ratio of having a B.M.I. over 30 so being obese. And then there were sexual risks of course some of these kids grow up in a family where they haven't had anyone pay attention to them they haven't had mothering or fathering and so they go out looking for someone to supply that need and that comes in in the form of illicit sexual behavior so aces are definitely related to subsequent unintended pregnancies infections with Estee These an increased chance that a girl will be having sex by SHE time she's 15 it's even associate with auto immune diseases compared to people who had no aces if you have 2 or more aces you're 70 percent increased have an increased chance of a T one mediated auto immune disease such as mild heart itis and 80 percent increased chance of A T 2 mediated such as minus any and gravitas and 100 percent increase rate every manic disease. But this is the one that's astounded me the most the heart disease risk 9 of 10 categories of aces were significantly increasing the risk of heart disease by one point 3 to one point 7 times in fact when you take the correlation between a scores in the scheme and heart disease it's actually mediated more strongly by those psychologic scores Ace's them by the traditional. Heart disease factors that we always use of cholesterol hypertension and what else that we use smoking anyway it's a much more likely that you'll have a heart attack if you have a high A score even without those negative behaviors what about chronic health diseases there were higher rates of liver disease chronic head headaches cancers C O P D and diabetes and of course mental illness also increased with higher scores higher rates of smoking depression and on the suicidality in P.T.S.D.. So this chart really says that to me too in the chart we see that one out of 100 people with 0 aces attempts suicide but if you have a score of 3 it goes up to 10 out of 100 people 10 percent will attempt suicide and if you go up to a score of 7 you have 20 out of 100 people attempting suicide so the suicide rates go up dramatically so why should we even talk about races with our patients my providers were so worried they would trigger off a patient to go home and commit suicide or to be depressed if they discussed these adverse childhood experiences in the office. But what happens is it actually cuts those symptoms scores by about 30 percent and it opens up the door for a patient to see what's the real question that needs to be asked in the office which is not what's wrong with you but what have you suffered what have you been through what have you survived and I tell my patients before I give them a quiz those things that you've been through those are what make you compassionate and strong and wise I think it was Winston Churchill that said a diamond is just cold it's done well under pressure so I tell my patients you know you're a gem you've been through a lot and your survivor. So it's an opportunity for patients to share stories if they want to they don't always but sometimes they do and in fact I've found that even when patients have a 0 a score just the fact of giving them the opportunity to take the quiz often brings up stories I had one patient who was struggling with alcoholism and other drugs and had a very troubled marriage was virtually abusive had been changing jobs a lot some tough it dysfunction in his home life and so I asked him if he'd be willing to take the quiz he took it he scored 0 however he had a significant event that happened in his grade school years where he had been lost in the snow on a field trip for many hours and they had to search for him with dogs and helicopters and so here's this young early elementary child who's feeling very alone and left out and it was such a traumatic event that when I gave him this quiz He said Well I don't have any of those things but this is what I have that I think is affecting me I also had a patient who scored very low on the ace's who was a patient of mine for osteoarthritis chronic pain depression also had fibro myalgia and his score was low but he said there is something in my childhood that's even more than all of these things and that is that I was the not I was not a good kid I was mean to animals I shot birds I was his I just had this horrible guilt from my childhood so he was able to bring that up spontaneously and felt that that was related to some of his current illnesses. So it's an opening also for spiritual care and human opening to help patients make better health choices so that in coping with this high level of stress from their childhood they make better choices about how to react to it how to respond to it. So here's how I do it I think most of you do have this paper in front of you. So I put it on a clipboard and I hand it to my patient and I say Would you be interested in taking a quiz that might cut your symptom scores of whatever illness they came to see me about by 30 percent would you be inches is just a 3 minute quiz I don't even have to see the paper when you're done what I'd like you to do exe give me a number if you don't mind and just that's all you need to do and I said and I told them many of us have adverse childhood experiences this is this is a common event but it often really impacts our health and the only question that the provider needs to ask is How do you think these things are affecting your current health that's the only question you have to ask and I have had only one patient refused to take this course of I've given out many dozens probably several 100 now and the one patient reviews came to me the day that he had shot a para one and he was struggling with alcohol use and cannabis and he did say I don't want to take the quiz today but I'll come back and see you just the fact that I opened the door to ask those questions made him decide to come back. So whenever you talk about adverse childhood experiences you also need to talk a little bit about resiliency and that's really enough to talk about a whole nother lecture but I do want to mention it and that is. In the cases too high dot org website there is a resiliency quiz as well and I think about Elizabeth Smart Does anybody know who is a smart was a few people in the audience this was a 14 year old girl who was abducted I think from Salt Lake City somewhere in Utah I think it was a good Mormon girl and she was stolen from her bedroom in the middle of the night knifepoint her sister actually thought it was a gun but later on they decide it was a knife and taken away and this crazy man assaulted her physically raped her over a period of about 9 months before they finally found her and brought her home but after she came home her mother told her they have stolen 9 months of your life they do not deserve a single 2nd more of your life and this is a very resilient message that is we can't change the events that happened to us but we can change our How to toot about how we approach them and this is huge in dealing with being smart says that she lives by her mom's advice to move on and find happiness she's making a conscious choice to define herself by who she's become rather than by what happened to her it's not what happens to us that defines us it's how we respond to it and she has been an activist for safety for women and for many good causes she's a harpist. So so the events happen but they are transient or temporal and the meaning of those events can last a lifetime so I tell my patients that it's like the devil likes to put post notes all over us you know he sends an assault of a vent to us and he wants to attach meanings to it like we're not good enough or we bear some part of the blame for or it's our fault or you know various negative messages but we could decide whose messages we will believe the devils or gods we have to choose what will believe and I love Romans $828.00 that says we know that God causes all things to work together for good to those who love him and are called according to His purpose. So how do we cope from adverse experiences Well the Porton thing to do is to substitute negative coping strategies with positive ones so positive strategies can you think of some. Exercise is one of them yeah healthy lifestyle getting out in nature. So when I do spiritual care with my patients who have high a scores I listen to their stories 1st listen to what their needs are what messages they're attaching to the trauma from their childhood and I ask them questions What gives you hope what gives you meaning what gives you comfort strength peace love connection what helps you when you're stressed and if they tell me my dog or a favorite television rerun then I might ask them who do you turn to when life's difficult or was there ever a spiritual connection in your life and if so what does that look like for you. I oftentimes give out to your bottles and I'll show you a picture coming up here with Psalms 568 written down God sees our tears in his bottle and writes them in his book he records the wanderings of our life and I tell them you know there is a God in heaven saw what you have gone through sees it knows your pain and cares about you who walks with you and now often times more bring patients to tears and I you get hugs after that. I use a lot of scripture. And we have a women's group that meets on Tuesday nights at 630 so I can invite my patients to it and we use a book called Treasures out of trauma which is a workbook if anyone is interested in having one I brought some with me. You could probably use other resources to the author of this book is a Sabbath keeping now. But it just is a very logical progression through scripture using scripture memorization as therapy she spends a lot of time in Psalms $119.00 was what which is what God's word does in Mass and what we do with God's word. So here's some of the text that we use in our in our Tuesday night Group one of my ferrets a 2nd Corinthians 4 verse 1618 so we do not lose heart there are ourself is wasting away our inner self is being renewed day by day for this light momentary affliction is preparing for us an eternal wait of glory beyond all comparison as we look not to the things that are seen but to the things that are on scene where the things that are seen are transient but the things that are unseen are eternal and of course patients always look at them see light momentary reflection Are you kidding what I've been through is not light momentary reflection but what was part about when he wrote this it was talking about being beaten and imprisoned shipwrecked. So James 12 to 4 is another one of our favorites consider all joy my brother and my sisters when you encounter various trials knowing that the testing of your faith produces in durance and let in durance have its perfect result so that you may be perfect and complete lacking in nothing and 1st Peter for 12 beloved think it not strange concerning the fiery trial which is to try you as though some strange thing happened to you but rejoice in as much as you are per takers of Christ sufferings that when his glory shall be revealed he may be made glad also with exceeding joy Jesus Christ suffer. And if we're going to be like him do you think we might have to suffer I think so we'll. I love the middle section of Romans 8 when I have patients who are struggling with addictions I really suggest that they start memorizing Romans 8 because it's very powerful for allowing the spirit to take control and stead of the flash and in the middle it talks about how we are sons or in the case of my women's group daughters of God we have not received a spirit of slavery leading to fear again but we've been adopted by God we are errors of God fellow heirs of Christ and if indeed we suffer with him so that we may also be glorified with him so this is conditional was the condition of being fellow errors with Christ that we suffer with him so that we can be glorified with him that is the chosen mechanism for us to become like Him and to become draw into his heart when we are suffering we are born into his heart for I consider that the sufferings of this present time are now worthy to be compared with the glory that is to be revealed to us and I like Romans $51.00 to $52.00 talks about how we have peace with God and we have this introduction by faith into this greatest in which we stand and we exalt in hope of the glory of God What's the glory of God the glory of God is his character his character and the way he brings us to be like him is to take us through these tribulations with him not alone and we exalt in our tribulations knowing that tribulations bring about perseverance and perseverance proving character improving character hope and hope does not shame down or disappoint because the love of God is poured out with our hearts by the Holy Spirit. And I love Isaiah 61 so many verses and I see as 61 there's actually a study. About Isaiah 61 by Mary Beth more that's more who. I think it's about 10 weeks or so we've done with one of my women's groups. And Isaiah 61 it says The Lord has anointed us to bring good news to the poor and are these patients who have been through so much the poor they really are some of them are depressed and physically affected by so many things they've gone through it says that he has sent us to bind up the brokenhearted to proclaim liberty to the captives some of these patients are bang on by their past and we need to let them know that there have to be bound by their past God gives duty for ashes oil of gladness for morning so I think there is a bereavement a morning that goes on about these childhood traumas. God promises that we are the planting of the Lord to glorify Him there is that word again glorify him to raise up the devastations of many generations now these are generational patterns of abuse which we can change by talking about it and by changing by the way we respond to it. But instead a shame God promises to give us a double portion of joy. And I particularly like Psalms 34 verses 17 to 20 which is when the righteous cry for help the Lord hears and delivers them out of all their troubles and that word troubles is the Hebrew Sarai which means tight places the places where we are oppressed by the devil God delivers us out of those troubles now does it mean that will never go through anything difficult. No it doesn't mean will never go through any of the qualities but it means that God will never allow our spirit or soul to be drawn down that we are on a heavenly journey our vision is not transient it it's not temporal it's a tonal many are the afflictions of the righteous but the Lord delivers them out of them all he keeps all his bones not one of them is broken I love that the way it refers back to Jesus Christ in that verse you know the sufferings even of Jesus Christ were measured God the Father did not neglect him when he was on the cross none of his bones were broken like the other believes of Macross So I want to talk about a case study. There is about 10 who is a 64 year old white male of mine with type 2 diabetes when my primary care patients he has hypertension obesity chronic neck pain with 2 failed surgeries. Major Depressive Disorder and insomnia when he 1st came to me he was on high doses of Norco days upon me and that's a big no no together he was also infantrymen for his chronic depression and insulin and statens and aspirin in the antidepressants he is a retired Hell's Angel he is a barbecue chef a competition fisherman. And what gives him meaning is actually this competition fishing and he hasn't been able to do that because of his neck pain you have to go faster all the waves to be a competition fisherman on like Orville. So his chief complaint was that he had been on a horrible binge over the Thanksgiving holiday and this really disturbed him because he had gotten his diabetes into really good control and I got drunk I just don't understand I was doing so well and I just went I mean like I was eating whole pies and he didn't understand it so in his bases his primary hit that came up was the loss of 3 relatives in the holidays so I asked him Do you remember any losses close to the holiday it's like oh wow of course I knew him that's like spot on of course I was I was grieving he had had 3 relatives an uncle his father and one of the relative that had died right about that time so we were able to talk about that process that he he doesn't believe in the same God the same way I do he believes there's this big man in the sky as he calls it but we we talked about the spiritual aspect of his grief. So I asked those spiritual questions to my patients do you have any spiritual support system has that ever been a part of your life wherever part of a spiritual community how was that for you because some people have had very negative experiences do you pray does that help you would you like me to pray with you now and it's rare that somebody refuses to have prayer so here's another case study. There's a 31 year old prime minister who was admitted at 38 weeks of gestation with headache and blood pressure of 169 or 110 to Kaiser facility where our I did my residency there was no proteinuria she was treated with bed rest left our position and the expeditious delivery and the mother and the baby did very well. But notable in her past medical history she had gained 70 pounds during that pregnancy she had a family history with a father who had hypertension and in my actually had 4 M.I.A.'s by the time he was 69 and died from his 4th one and a paternal grandmother with type 2 diabetes and a mother who had depression so if you didn't ace history on K. you would find out that her parents were divorced before she was 4 now it's one hit she had childhood sexual abuse she had an attempted gang rape when she was about 6 an alcoholic father who attempted suicide when she was 11 and attempted rape at age 17 washers driving home from or sh T. class. Mother who had depression an eating disorder and committed suicide the day before the patients 18th birthday. The patients a square was at least for. One clinical possible possible explanation for the patients hypertension with no prone area was that the patient was experiencing not pre-eclampsia But if you're retry it is a shot with the delivery. So what happened to this patient. After she delivered her baby she decided to lose the 70 pounds and began jogging to diet center every day and on her way jogging to diet center a few guys whistled at her from a truck and she dissolved into tears it hit her immediately there was a connection between the extra weight which is a protection perceived protection from assault from being having unwanted attention and also that being on an $1100.00 calorie diets and diet did not give her the carbs to suppress the negative emotions. So she wasn't pushing down those old memories so she immediately went into a group of private counseling she read door of hope by Jan Frank disappointment God by Philip Yancey for in your mind for memories that by Mary for out of Florence the tower and healing for damaged emotions by David seaman's to begin having dreams at night that brought out some of the memories that she had suppressed from childhood talk with her cousins confirm their continued counseling when her baby was about 9 months old and was weaned she put him in the care of her husband then and his mom and went away for the to the beach for 3 days and stormed up and down the beach angry with God for what she perceived as as unfair salts from childhood. But during that time with all the books she concentrated on the Bible text Bible therapy very very healing she used journaling prayer scripture memorization exercise healthy evening eating and chose to base your identity not on the things that happen to her but on the person God says that she is. So. This is what we do in our women's groups this is exactly what we do and when we do use this manual treasures out of trauma by early in Hendrix but you could probably use other books I think you could probably use a ministry of healing would probably work very well so I love the idea of the 2 bottles of my patience God save our tears in his bottle writes them in his book he records our wanderings and I specially like this one Psalms 275 for in the day of trouble he will conceal me in his tabernacle in the secret place it is tent he will hide me to lift me up on a rock. So I want to tell you K. was me and I have absolutely no memories of pain for any of those negative events that happened in my childhood and most psychologist or psychiatrist will tell you that was dissociation but what God has told me is that I put you to sleep just like I did for Adam when I took the rebel I put you up in my tabernacle in the secret place of this tent now he had me and it was interesting because I had some light lower crime pain pain for some years off and on and went to a couple doctors and and when I had a gallbladder out they noticed him and he was down there I'd never had a part of a confection but when I had a hysterectomy in age 60 the doctor came to me and said your right to an ovary were so scored to your uterus that I had to remove them together and it was from the time that I was pushed by the group of boys within me and my growing just terrible scarring but I had no memory of that pain not now God is amazing he is very very good to us and these experiences from my childhood have left me more compassionate to my patients able to empathize with them it's been a good thing there was a time when I would have extincted all those things but not anymore. God says that we are His children we are Christ's friend were bought with a price we belong to God we're redeemed and forgiven the Valar sins were complete in Christ precious in His sight were his workmanship created in Christ. We've been established anointed sealed by God with not being given a spirit of fear but of love power and a sound mind were born of God and the Evil One cannot touch us he might be able to do things to our transient temporal outside body but he can't touch our soul can't touch that vibrant relationship with God can't touch our eternal destiny we are seated with Christ in the heavenly realm. There 432 says when you pass through the waters I'll be with you and through the rivers they shall not overflow you when you walk in the fire you shall not be burnt nor shall the flame Kindle you. So I have some references here and I'm happy to since lines to anybody who wants to leave me an email address. Any questions I'll take around to Mike if you owned books if anybody wants books they actually if you order them on Amazon they're $20.00 apiece but I can get them for $5.00 apiece from the author so if anybody wants to leave a donation for books that spine if you don't have cash with you want to just take a book that's why into any questions. I'm sorry we came late I didn't get here did you mention the you have a support group or something less we run a group on Tuesday nights at our church which we have right now we only have 6 ladies coming myself and one other administers the other 4 from various churches in town so it's an 18 week course if we go through the lessons from the book but we've now continued into other Bible topics so. We might just go into Daniel Revelation one of these days that's wonderful and how did how did you initially make contact with these patients that came through or I 1st contacted with the author working with her on an organic farm and got to know her got to know about her book and. Just we just started when I was when I would meet patients in my office I was giving out a lot of her books and so she had to reprint a new badge and then we decided it was just me and talk with people and it's been an amazing experience that the women send mean text during the week it's am and I've just learned so much because we're teaching them to depend on God's identity of them and not what the devil wants to post note all over them President thank you so much for you know sharing your story and getting vulnerable that's the beautiful how the other says no you know it's interesting my my daughter said Mom when you give this talk you have to tell your story and I don't know I don't think so but I went to a women's a retreat a couple weekends ago and I'm like over and over and over again under story was references to telling our stories and one of the talks was about telling her stories to God's glory and so I was getting ready for church that morning and learns and I want you to tell their story and I said I don't know what I don't know about that and he said I gave you the story I want you to tell it just like Joseph Story and Esther story and Daniel story I want you to tell your story and that's true for every one of us. Thank you. QUESTION Dr. Carey can you take the mike back. After you've told your story Dave to their story a moment going to say it like this what happens next and is it healing the room the Word of God that does heal Oh yeah or does it is an ongoing kind of a gotta stay together gotta keep this thing we stand 10 to meet for 18 weeks when we start a group and we actually have a group that I am part of called Hearts being healed when we do a retreat twice a year in our area we do one in Porto in September and 1 in Chico in March and we bring in women from all different walks of life with different stories they tell their story with a definite scriptural emphasis about how God has written his story in them and our emphasis is on using the word of God for healing and that is our primary and if women want to continue meeting after that 18 we are open to that but you find that there is definitely healing I'd say has started to take place oh sure and if they continue to view themselves different I like that concept of what is it's happened yet what can you do about it in telling your story sometimes we play down on people don't talk about that let's move on yes but I think you do have to but I like that I just appreciate what you've shared and no one has to talk in the groups Yeah I mean I don't I have some women who might come for a 9 weeks before they say a word. So it's not a forced No no it's totally voluntary and we just go we we memorise Scripture we usually choose a verse to memorize we read it on the board and we talk about different memorization techniques and it's very powerful sounds like it congratulations. Any more questions. And I think I saw your bio that you work at a good health I was doing I work at Feather River Tribal Health and we just built a brand new lifestyle center so I'm hoping that my boss will get a new medical director and let me direct life stuff and interesting so I'm curious. I also work in Indian health center part time. And. The population that we serve as a very high prevalence of adverse health has events I'm curious how you integrate this spiritual part of the treatment while you're in a facility like this where you know we have federal regulations and all that stuff we have to kind of be careful about what we do how do you talk to you that I talk about the Creator most Native Americans are very open to the idea of the creator and I asked them what their view of God is or what their view of the Creator is many of them talk about the grandfather they have a grandfather in in the sky that's taking care of them so I start with their cultural view of God and a many of my patients actually have Christian roots I've only had one point one maybe 2 patients in my 11 years working there who have complained about spiritual care and actually one of them said I still wonder as my doctor but I don't want to ask any spiritual questions and later on I happened to go to a funeral at his church which is one of the church in this that is a non-denominational they don't even really believe I think in the Trinity or. That but he later on he started inviting me to events at his church. And I mean the other person who complained was like about. And I actually had one young woman who said she was a pagan and I asked her what that meant to her her mother was in the room and I was going through the 8 natural remedies with her and the last one just says trust it doesn't specify so I leave that open so I can talk more impending on their event and I said you know people have trust in a good power do better and that was the word I use trust and good pair and the mother wrote a complaint to ministration saying I had said Jesus she heard Jesus. And I know that the Devils present some of those visits as well as a ward. I told my boss I didn't say Jesus I said a good higher power but I start where they're at. We relate sorry I really appreciated your tie Thanks for sharing your testimony and I had I saw this a score question here how do you how do you use this talk so so the way and I put it on a clipboard and I tell the patient that if you'd like to take this little quiz it has the potential of cutting your symptoms scores by about 30 percent you don't even need to show it to me if you want you can give me your number your total number of yeses that out of 10 and. And then the only question I ask is How do you think these events in your childhood are affecting your current health that's the only question I have to ask and it just opens the door for questions and for a transition into spiritual care for them to share stories. Thank you. I haven't started screening everyone yet but I think it would be a great idea I screen all my chronic pain patients all my fiber my older patients all my depression patients all my anxiety patients so I'll probably get to the point where it's great everybody I should be is grading on my hypertensive patients for sure so all my diabetic exam because this court is all you know the flight or fight gone gone wrong that ends up with high cortisol response and P.T.S.D. is a part of so many illnesses as we saw in the lecture so. Anybody else questions I just wanted to say thanks I think this is something that's very overlooked in healthcare today. You know I work even value lifestyles in our natural wellness center and we see a lot of cancer indeed in Valley last year I think it was we kept some very loose numbers in a very small demographic obviously but we look at all of our cancer patients and we have motional and spiritual component to our program as well and we found that 100 percent over the it was a 6 month period 100 percent of our cancer patient regardless of age and sex 100 percent had some sort of physical emotional or sexual abuse or trauma right it's incredibly probable very much so. Thank you this talk was excellent so I'm in pediatrics where the trauma occurs do you have any resources that you recommend specifically for entertaining earlier before they make it to your clinic with the emotional baggage from childhood there are some and I could probably send you some e-mail resources I think the most important factor is having an attentive understanding adult who draws near right after the trauma so if you have a supportive mil you process the trauma that's huge one of the question is this the sort of thing that you perhaps would start in a church group or would you have to be a medical professional to say even initiate this kind of program Oh I don't think you need to be a medical professional all this this treasures out of trauma book that's on Amazon also comes with videos you can just play the video and then discuss that with Lawson I think it could be easily run in a church OK Thank you. Real quick Could you just go through the 1st like 12 slides that have all the statistics about why it's important health care I think a lot of people came in after Sure when he got through that sure back. Sure. I work with refugees and we've been working with Andrew's University their social services department and also A.S.A.P. and they've got a tremendous program that they're using with the children and the mothers in the refugee camps of overseas and now they realize that we have some of the same refugees so they're starting to come up and and I help us with ours in our area. But I appreciate this because this is now given me a medical model I'm a nurse but public health and now I've got another model to work in there and they're using the laws of health in because God has set up ways of healing in the brain ask labeling is just fantastic exactly in a lot of hope here so this lecture was based on the Kaiser study on adverse childhood experiences that was done by Dr Vincent the lady F E L I T T I from 1995 to 1997 it was published in 1988 about the relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults it was conducted at Kaiser Hospital from 1997 on 17300 patients and Bob under from the C.D.C. participated with him so that 10 factors are abuse either physical emotionally or sexual neglect physical or emotional neglect and household dysfunctions like mental illness parent being treated by a lightly a divorce and incarcerated relative or substance abuse. So when they did the national study it was 75 percent of people who had been partially or fully call the edge educated and 75 percent white people if they had done this in my neighborhood growing up in the gangs of Los Angeles I think these numbers would have been much higher. So we found out that 64 percent of adults have a least one a score and 12 and a half percent of adults have 4 more. So 28 percent of people have been physically abused 21 percent have been sexually abused and it's dramatic and there's a dose response curve for the number of basins to the amount of adult disease. So dull. Has the effects coming from 1st the adverse childhood experiences than the disrupted neuro development watts of high cortisol levels P.T.S.D. social emotional and cognitive impairment and the adoption of health risk behaviors but we know that even if you don't adopt negative health risk behaviors you still have a higher risk of new disease and cancer and diabetes and heart disease just having been through those traumas in childhood. And life expectancy if you have 6 or more aces is cut by 20 years. From 80 down to 60 so it tends to show up in adulthood as behaviors like lack of physical activity smoking alcoholism drug use and missed work and then physical and mental health impacts such as severe obesity diabetes depression suicide attempts S.T.D. heart disease cancer strokes the O.B.D. broken bones disorders and the heart when that's huge it's a bigger risk factor to have aces than it is to be smoking with hypertension and hyperlipidemia. So it impacts the 1st use of alcohol much earlier when children who had the highest scores drug use the risk of each a score increased the likelihood of early drug use by $2.00 to $4.00 times. Obesity the. People who had been physically and verbally abused had a 4 Keilar higher weight and one point 4 times relative risk of having a B.M.I. over 30 which is obese. So higher sexual risky behavior and I don't mean to say. Thank you so much at the end of our session you have a 10 minute break and I was actually I'm happy to answer questions. This media was brought to you by audio verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse if you would like to listen to more sermon leave the Visit W W W audio verse or.

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