Welcome to the Cerulean Elephant!



Here we talk about everything and anything. This is a non-judgemental place. Questions are always allowed but hate will not be tolerated.


Death and Dying

Death and Dying

What is death and dying? For most people it is quite a difficult topic to talk about. I am very fortunate to have grown in a family who cherished death and treated it as another celebration such as a birthday or graduation. As I have gone further into my nursing career, I have discovered my love for caring for patients who are at the end of their journey here on Earth. There is something very special about being with someone during their last days. It’s quite a unique experience.

So I wanted to create a topic board on here where I will talk about death, the dying process, hospice and palliative care, traditions and wives tales, and different religious aspects of death and dying.

According to Merriam-Webster, the definition of death is as follows:

the action or fact of dying or being killed; the end of the life of a person or organism.

They also define dying as:

Gradually ceasing to exist or function; in decline and about to disappear.

Death is not the worst thing that can happen to a person. That’s what my mom taught me when I was just four years old. My Uncle had passed away from an abdominal aortic aneurysm. My mom sat me down and explained what dying was to me. She taught me that it was a very natural part of life and that of course it is always ok to be sad and miss that person but we should be happy for that person as well. Both the German and Polish sides of my family celebrate death. Typically, after the funeral we go to a dining hall and have a big meal and share stories about our loved one who has passed.

Nursing has very much proven to me that death is in fact not the worst thing to happen to somebody. Unfortunately many times we have patients who never thought it would happen to them and do not have living wills and power of attorneys. They can sit for days or months or years in very unnatural states of being, typically suffering from pain. Hospice is a great gift that we have but unfortunately do not utilize enough in the hospital. With hospice we can make patients comfortable until their death. It is my goal to educate as many people as I can about death and hospice and keeping our loved ones comfortable. We often times witness family being quite selfish and “doing everything” to keep their loved one alive. However, in the long run it is the patient who suffers.

Hopefully this board with give you some insight into why we should be celebrating death and how we can make it a more acceptable topic of conversation. More to come later!

Mental Health, Mental Health Mondays

Mental Health Monday: What it is like to have Seasonal Affective Depressive Disorder.

Hey Guys! Welcome back to another Mental Health Monday! You have probably been wondering where I have been! Well it has to do with today’s topic of Seasonal Affective Depressive Disorder (SADD or SAD). Tis the season for darkness around 4:30-5:00 pm.

Seasonal Affective Depressive Disorder can happen in the summer too. It is rare but does occur. Today though we are going to be talking about winter SADD. Now, as you all know I have clinical depression. This makes me more likely to have SADD, however you do not need to have clinical depression to have SADD. You may also not trigger your Clinical Depression with SADD. Absolutely depends on the person. Today, I am going to talk from my experiences, not necessarily researched evidence.

I grew up in Northeastern Pennsylvania. Cold, literally a majority of the year; so as long as I can remember the darkness made me miserable. But this was normal. When I moved to North Carolina though, I didn’t realize how miserable I had been because now I had more sunlight exposure for a longer part of the year. My experience also tells me I am sensitive to not only darkness but several other things including: temperature drop, barometric changes and altitudes. These typically go hand in hand so there’s no surprises here.

My signs and symptoms start in mid-October with me having more difficulty than normal controlling my temperature (thyroid disease; always cold). I am typically wearing at least two pairs of socks and a sweater. Next, my need for sleep drastically increases. I go from needing 4-6 hours minimum to about 8-14 depending on the situation. Doesn’t sound like a big difference but my goodness is it! My eating habits usually go out the window as if working night shift didn’t already do that; leading to weight gain. I do not like to go outside or socialize. I feel bad for my puppy because all he wants to do is go to the park his normal two times a day but that even becomes difficult for me. I literally have to write down on a post it that “Maverick cannot suffer because you do not want to go outside.”

There is more but those are my major issues. Others include my hair falling out more, my memory fades, I have increased headaches and joint pain and so on. I cope but by far the worst is when the Seasonal Affective turns into or partners with my Clinical Depression. I spend days guessing if I should make a psychology appointment. Typically, I do wait long enough (ugh, I know) until I have a “mental health event” (prettier and less harmful term for a breakdown). Example being, this week I put up our Christmas tree that we have had for only four years. I cried because it would not light up and I had to go to Target to get more lights. Reality: it’s not about the lights. It’s that the Christmas tree is the only thing that really makes me happy this time of year because it reminds me of my mom and dad and my childhood home. My parents did and still give the Griswold’s a run for their money. So, I emailed my psychologist for an appointment. I am very lucky that the experiences I have had with therapy and my clinical depression in the past makes seeking help so much easier now. I am not embarrassed and willingly go.

I do encourage you though, as HARD as it is, to take preventative measures to help yourself. I went out and bought natural light lightbulbs that cost an arm and a leg, worth it. I make sure I go outside for at least 20 minutes a day, even if I have to write it down to remember it. I try my absolute hardest to go to the gym. Usually this fails so I make my 20 minutes of outside time a walk. Make it a point to do things you love even if it is in small increments. Make lists if this is the only way you can remember things. It’s ok!  If Seasonal Affective is new for you or you are just struggling more, go see your doctor. Any doctor, it could even be your primary care if you do not have a psychologist.

I want to put a reminder in here that you can always call the Suicide Hotline toll free at 1-800-273-8255. Please note that you do not need to be suicidal to call, you can just simply need help. They will direct you to the care that is best for you. Suicide rates can increase this time of year. Not only because of the darkness and weather but because of holidays. They can be quite complicated for people. I am 100% here for you if you need someone to vent to.

Hope you all are doing great and I cannot wait to get back into the swing of things! Have a wonderful Mental Health Monday and Break the Stigma!

Mental Health, Mental Health Mondays

Mental Health Monday: Substance Abuse Disorders -Alcohol

Welcome back to Mental Health Monday! Today we will be talking about Substance Abuse Disorders. Specifically we will discuss Alcohol which is also called Ethanol and can be abbreviated as ETOH. Substances are used by people because they can have varying effects. The two usual feelings are increased pleasure or decrease in feelings.

Substance abuse disorders include the following:

  • Abuse of alcohol or other drugs which lead to work, school, home or health problems.
  • Dependence on these substances.

Symptoms of substance dependence are:

  • Tolerance for the substance; the amount needs to constantly be increased to get the same effect.
  • Problems with withdrawal.
  • Use of larger amounts than intended.
  • Problems cutting back or controlling use.
  • A lot of times spent getting the substance, using it, and recovering from it.
  • The person gives up or reduces time in normal social situations like school and work.
  • Using despite knowing consequences.

About 8% of the population age 12 and older have a substance abuse disorder in a given year. These disorders tend to start in the teenage or early adult years with the mean being 20 year old. Substance abuse is twice as high in males than in females. Often times, substance abuse occurs with other mental health disorders and just the same, people with anxiety or mood disorders are twice as likely to use a substance. Substances are used as self medication to deal with the side effects. This is usually because these substances are either legal or more easily accessed than mental health care and medication.

Alcohol makes people less alert and impairs concentration and coordination. The government defines low risk social drinking as the following:

  • Men: no more than four drinks per day, no more than 14 drinks a week.
  • Women: no more than three drinks per day, no more than 7 drinks per week.
  • 65+ years old: no more than three drinks a day.

The US Standard drink equivalents are as followed:

  • 12 oz beer at approximately 5% alcohol.
  • 8-9 oz of malt liquor at approximately 7% alcohol.
  • 5 oz of table wine at approximately 12 % alcohol.
  • 1.5 oz of spirits at approximately 40% alcohol.

The legal Blood Alcohol Concentration (BAC) across the United States is 0.08%. This is the legal amount of alcohol that is required to be issued a Driving Under the Influence.

Short term problems caused by alcohol include physical injuries, aggression, antisocial behavior, sexual risk taking, suicide and self injury. Long term problems caused by alcohol use include alcohol abuse disorders, other substance abuse disorders such as illicit drugs, depression, anxiety, social problems like avoiding work or school, and physical health problems such as organ damage and failure.

The medical complications of alcohol include: slurred speech, motor impairment, confusion, memory and concentration problems, poor decision making, choking, vomiting, depressed breathing, seizures, coma and death. Wernicke-Korsakoff Syndrome is a disease in which you lack Vitamin B (thiamine). Vitamin deficits are often seen in alcoholics. Alcohol Poisoning occurs when large amount of alcohol is consumed in a small amount of time. This is also called binging. Signs of alcohol poisoning start at a BAC of 0.16% and significant death rates start at 0.3%. Always call 911 in the situations. These people cannot recover at home.

Hangovers are a group of signs and symptoms that you have after drinking large amounts of alcohol. Some hangovers can take up to 24 hours to go away but thankfully usually do resolve on their own with adequate hydration, electrolyte replacement and ibuprofen. The actual cause of the hangover is when your BAC drops significantly to zero, typically occurring the next morning. Other reasons you don’t feel well is because alcohol irritates the lining of the stomach, drops blood glucose levels, has an autoimmune inflammatory response, causes you to produce more urine making you dehydrated, and it causes blood vessels to contract causing the headaches. You will see the following symptoms:

  • Fatigue and weakness
  • Excessive thirst and dry mouth
  • Headaches and muscle aches
  • Nausea, vomiting or stomach pain
  • Poor or decreased sleep
  • Increased sensitivity to light and sound
  • Dizziness or a sense of the room spinning
  • Shakiness
  • Decreased ability to concentrate
  • Mood disturbances, such as depression, anxiety and irritability
  • Rapid heartbeat

You should call a doctor if the hangover does not go away on its own or you start seeing symptoms of severe alcohol poisoning. These include:

  • Confusion
  • Vomiting
  • Seizures
  • Slow breathing (less than eight breaths a minute)
  • Irregular breathing (a gap of more than 10 seconds between breaths)
  • Blue-tinged skin or pale skin
  • Low body temperature (hypothermia)
  • Difficulty remaining conscious
  • Passing out (unconsciousness) and can’t be awakened

The Rapid Alcohol Problems Screen or the RAPS4 is a questionnaire designed to determine if someone is drinking over the “normal” low risk drinking level. It gets its name for the four points it asks about: R: remorse , A: amnesia, P: performance, S: starter drinking behavior.

The questions are as followed:

  1. During the past year, have you had a feeling of guilt or remorse after drinking?
  2. During the past year, has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
  3. During the past year, have you failed to do what was normal expected from you because of drinking?
  4. Do you sometimes take a drink in the morning when you first get up?

If YES is answered to at least one of the four questions, it is suggestive that their drinking is harmful to their health and well being. At this time the person should have a full medical evaluation by a professional.

Treatment can go two typical ways but these are not always the case. The first is the family and friends of the person have an intervention and they talk about different things. Usually how great of person they are but how alcohol is controlling them and making them a different person. The family and friends usually offer help and have a rehab set up for the person to go to. The other way that I see often is through the hospital. People come in and are very intoxicated. We give them different medications like Precedex and Librium to safely detox them. Once they are medically stable we can transfer them to a rehab facility or psychiatric facility based on the needs of the patient. Unfortunately, often times we send them home because they are not ready to accept the help and they continue on with their addiction. The underlying cause of drinking needs to be assessed and treated as well!


Thanks for coming back! Next week we continue with Illicit Drug Abuse.

  1. http://www.MentalHealthFirstAid.org
  2. 2. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption
  3. 3. https://www.alcohol.org/faq/what-is-alcohol-poisoning/
  4. 4. https://www.mayoclinic.org/diseases-conditions/hangovers/symptoms-causes/syc-20373012
Mental Health, Mental Health Mondays

Mental Health Monday: Obsessive Compulsive Disorder (OCD)

Welcome Back! This Monday we are going to be talking about Obsessive Compulsive Disorder or OCD. We will also briefly cover some subgroups.  OCD is classified under an anxiety disorder. It is the least common, affecting about 1% of the population with onset at about 19 years,  but one of the most disabling mental health disorders. Obsessive thoughts and compulsive behaviors make up this disorder. It is usually a life long illness and boys commonly are affected more often then girls.

Obsessive thoughts are reoccurring thoughts, feelings or images that are intrusive and unwanted and cause anxiety. The most common type of thoughts include fear of contamination, the need for equality or stability, safety, sexual or aggressive impulses and religious preoccupation. Compulsions are repetitive behaviors or acts that a person performs to relive the anxiety from their thoughts. Some common compulsions are washing, double checking, repeating, reordering, counting or hoarding.

“Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds (2).”

The causes of OCD are unknown but there are some risk factors that include: genetics in a first degree relative, brain structure (frontal cortex and subcortical structures are different), and sexual or physical abuse as a child. Some children develop OCD after a Steptococcal infection. It is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Treatments include medication and cognitive therapy. These people often suffer from other mental health disorders that should be treated in conjunction with the OCD. Serotonin reuptake inhibitors (SRIs), selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants are medications used to treat OCD. SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working.  A type of therapy called Exposure and Response Prevention can also help in teaching people about their compulsions, how to recognize them and adapt.

Impulse Control Disorders can be grouped as a sub specialty of OCD but some can now stand on their own in the DSM V.  People with these disorders cannot control the urge to hurt themselves as a result of their anxieties. The difference between these disorders and self harm is that impulse control disorders are the main diagnosis. It can be hard to differentiate. Some of these disorders are the following : addictions to alcohol or drugs, eating disorders, compulsive gambling, sexual fantasies and behaviors involving non-human objects, suffering, humiliation of children, compulsive hair pulling, stealing, fire setting, and intermittent explosive attacks of rage.

Most recently trichotillomania and dermatillomania have been added as subgroups of OCD. Trichotillomania is hair pulling from anywhere on the body but typically the scalp, eyebrows and eyelashes are the most common. The most severe type of trichotillomania is oral fixation where people will eat there hair once pulled. this often times leads to surgery as patients get bowel obstructions. Trichotillomania usually starts between 9 – 13 years old. Anxiety as well as boredom can trigger this.

Dermatillomania is also called excoriation disorder or skin picking. People may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), lesions, or scabs. A wide range of ages are affected by this disease but puberty years are the typical onset. 1.4% of adults have dermatillonmania and usually it is mostly seen in women. Infections can be seen in these people as they will continue to pick the same areas over and over.

I was recently diagnosed with dermatillomania and minor trichotillomania. I have been picking at my skin for as long as I can remember and my mom also does it. I also pull at my eyebrows and eyelashes. The worst part is I know that I shouldn’t do it but it is difficult to stop. I have had cellulitis in my leg and have scars all over the place from picking. Thankfully my anti-depressant takes care of most of this and I have not had an infection in a long time.

Thanks for reading! Hope you enjoyed! Can’t wait to talk to you next week. If you have any disease that you would like me to go over, feel free to ask!


  1. MentalHealthFirstAid.org
  2. OCD: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
  3. PANDAS: https://www.nimh.nih.gov/health/publications/pandas/index.shtml
  4. Impulse Control Disorders: https://psychcentral.com/lib/what-are-impulse-control-disorders/
  5. Trichotillomania: http://www.mentalhealthamerica.net/conditions/trichotillomania-hair-pulling
  6. Dermatillomania: http://www.mentalhealthamerica.net/conditions/excoriation-disorder-skin-picking-or-dermatillomania
Faces of Mental Health, Mental Health

Faces of Mental Health #1: D. (Female)

break the stigma

Welcome to the first Faces of Mental Health. I am quite excited about this and already have two volunteers. I will also be filling one of these questionnaires out. The point of this segment is to show that every day people we know and interact with can have a mental health disorder but are functioning members of society. My hope is to make talking about mental health a much more normal piece of conversation and less scary. So let’s begin!

1. What is your life like? Age, gender, sexual preference, home life, lifestyle?
  • I am a 40 year old female, a wife, and a mother of two daughters.
2. What is your diagnosis? Are there multiple?
  • I currently suffer from PTSD from a childhood trauma. I am in recovery from depression and anxiety.
3. What were your signs and symptoms? Did you know something was wrong?
  • When I was dealing with depression I felt tired, weak and extreme sadness. I was withdrawn and had no interest in the things I once enjoyed. When I was suffering from anxiety it felt like my heart was pounding out of my chest and I would sweat all over. I felt completely out of control. The symptoms from my PTSD were the worst! I started getting horrible headaches and forgetting things. I was confused throughout the day. I forgot where my daughters bedroom was and when I was looking in the mirror, I didn’t recognize myself. I had truly believed I had a brain tumor. We went all the way to Duke (University Medical Center) for testing and after a week of poking and prodding me, we realised it was my PTSD. My body was trying to remember things that happened to me when I was a child but my brain was shutting down because I didn’t want to remember. It was the worst time of my life. I remember being so scared.
4. Was there an aggravating factor to your diagnosis? Trauma? Stress? Genetics?
  • Depression runs in my family. My mom suffered from it for years. Childhood trauma- sexual abuse was the cause of my PTSD.
5. Did someone make you see a provider or did you seek out help yourself?
  • When I first experienced symptoms of depression I was a teenager and forced to see a therapist. Which by the way was the best thing I ever did. When I was dealing with PTSD, I knew I needed more intense treatment. So I checked myself into a residential treatment facility in Nashville, TN for two months. It was the hardest and the best thing I ever did.

6. What is your treatments? Medication? Therapy? Clinical trial?

  • I take an antidepressant to manage my depression. For a long time I used xanax to control my anxiety nut after going to the Ranch (treatment facility), I learned new ways to cope. I use breathing techniques, essential oils and meditation. As for my PTSD, I used to take medication to suppress my nightmares. A few months ago I stopped the meds and I am working through the flashbacks on my own.
7. Do you still participated in treatment? Why or why not? Doctors choice or yours?
  • I know longer see a therapist but I make sure not  to keep my feelings or thoughts to myself. I have done a couple of speaker meetings where I tell my story. I also used to run and Emotions Anonymous group up until recently where I could not only help others but could get my feelings out.
8. Did your religion or practices prevent you from reaching out?
  • Not at all! In fact I spoke to my church about what I had been through and how I had come back from it. And I believe that God had a lot to do with it.
9. Have you ever been suicidal? How did you feel?
  • Yes. When I was a teenager and severely depressed I wanted to die. I used to pray to God to take me in my sleep. I tried taking my pills but threw them up. I was just so hopeless that I didn’t want to be here anymore.
10. Did you ever self harm? Did it make you feel better or worse?
  • No.
11. What is something you wish people knew about your diagnosis’ or mental health in general?
  • I want people to know that mental illness is not something to be ashamed of. I’m actually grateful in a way for what I have gone through because it has made me the person I am today. And I am Strong!

Thanks for reading! Cannot wait to keep posting these and break the stigma!

Mental Health, Mental Health Mondays

Mental Health Monday: Post Traumatic Stress Disorder (PTSD)

Welcome back to Mental Health Monday. Today we will be talking about Post Traumatic Stress Disorder or PTSD. We will also talk about Acute Stress Disorder as this is a sub-type. PTSD is classified under an anxiety disorder. It affects about 3. 5% of the population with first experiences usually being around 23 years old (1). PTSD occurs after a person experiences a traumatic event. PTSD is typically associated with war and rape however it does include many other situations including the following; traffic accidents, physical accidents, assault of all kinds, sudden and unexpected death of a loved one, mugging, robbery, family violence, terror attacks, mass shootings, or severe weather events.

Acute Stress Disorder (ASD) is when the person that experiences these events can recover within three months and get back to a normal life. PTSD lasts much longer. ASD can very well turn into PTSD. This usually occurs when there are feelings of intense fear, helplessness, horror and there is no support fr the patient.

There are different types of symptom classifications for PTSD according to the NIMH (2):

  • Re-experience Symptoms – flashbacks, nightmares and frightening thoughts.
  • Avoidance Symptoms – avoiding triggers such as the places, events, or feelings
  • Arousal and Reactivity Symptoms – easily startled, feeling tense or on edge, insomnia and anger
  • Cognitive and Mood Symptoms – memory problems, negative thoughts, distorted feelings of guilt, blame, loss of interest in activities

*Children may have bed wetting, acting out, reverse in language or milestones, and being clingy towards one specific person.*

“To be diagnosed with PTSD, an adult must have all of the following for at least 1 month (2):

  • At least one re-experiencing symptom

  • At least one avoidance symptom

  • At least two arousal and reactivity symptoms

  • At least two cognition and mood symptoms”

There are very few risk factors as anybody can experience a trauma at any point in their life. There is no age restriction. Contrary to popular belief because of war (still predominately male), women are actually the gender most likely to experience PTSD.

Support groups are the leading cause of success in coping with PTSD. Medication such as antidepressants and sleeping medication may help but are almost always used in conjunction with talk therapy for PTSD. Talk therapy for PTSD usually last six to twelve months but can take as long as needed and may become chronic. Sometimes exposure therapy is used along with cognitive restructuring. This means that a reason for the events happening is found and discussed if possible.

This year I was diagnosed with ASD and eventually PTSD from witnessing and rendering care in a pedestrian versus car accident. It was May 31, 2018. It was really raining at my house so I left about 15 minutes earlier than I normally would have for work. It was super difficult to see because of the rain. I saw police lights on in the oncoming lane but thought nothing of it until I pulled up next to them. There was a man lying on the ground in front of a police car. The man had walked out in front of the police officer and landed about 25 feet away. Although I still cannot talk about details as the statute of limitations is not up, the police officer and I rendered care for about 15 minutes until the ambulance and fire company got there. I stayed until the very end because I had to talk with the police captain, fire chief, traffic police chief, and motor vehicle accident police chief. I was so calm throughout the whole thing. My nursing training was astonishing and I still cannot believe what I was capable of as I was never trained as a first responder or emergency room nurse. Once a nurse; always a nurse. The training always comes naturally. I did however get nauseated once because for the first time I did see brain matter that was alive and not from a bucket. Now during all of this it was pouring rain and I didn’t realize how wet I was until I stood up. Once I was in my car and wrapped up in a towel I keep in my car for situations like this, I called my mom as I drove to work. That’s when it all hit me and I was hysterical. This was just the adrenaline coming out. Once I got to work and changed clothes I was able to do my normal work. I went home after my shift and didn’t think anything of it. I woke up the next day and got ready for work.

Once I grabbed my keys I began to cry uncontrollably and had a panic attack. I was so scared to drive my car for the next few days because I was just waiting for the next accident. The reality though is one of these accidents happening is very rare to begin with let alone another one happening right afterwards. I couldn’t see or hear an ambulance without getting nauseated. Once the nightmares started though and I was waking up drenched in sweat or crying nonstop I knew it was time to go see my therapist again.

I went and talked to Dr. M and we went over the accident from beginning to end. Most of my issues surrounded the tremendous amount of “rescuers guilt.” It’s a very weird feeling and I really wish I had words to explain it, but until you experience something like that you can’t understand. Dr. M gave me some coping strategies and said since I have no prior traumas that it should take about 12 weeks to stop constantly thinking about the accident. It took me three months to get back to a okay place but I have to drive by the scene of the accident everyday. Not until recently did I notice I am not paying attention to that anymore as much. There are still random days I think about it but I do not get nauseated anymore when I hear or see sirens. Another interesting factor for me was there not being an obituary. Unfortunately but expected, the man did pass away. As a nurse we often times look for obituaries for our “closure.” This mans family chose not to release one and that was a little difficult for me. I still think about the officer that was with me. He was so young and looked so nervous. I wonder how he is coping. But my focus is on me now and trying to move on.

Thanks for coming back to another Mental Health Monday! Talk to you next week!

  1. MentalhealthFirstAid.org
  2. National Institute for Mental Health – https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145372