Removing cloak of silence best way to deter suicide

It's one of the last truly taboo topics, the shameful secret that few want to talk about -- and that silence can inadvertently lead to people taking their own lives.

Mental health advocates say that while the recent highly publicized suicides of several prominent sports figures have shone a spotlight on the issue, the lack of frank public discussion about causes and prevention is leaving those at risk for suicide and their loved ones as much in the dark as ever.

"We are trying to encourage informed and sensitive conversations on the topic of suicide," said Tim Wall, executive director of the Canadian Association for Suicide Prevention. "There is so much secrecy and shame that often surrounds this issue that it can be a difficult conversation to have."

Wall believes people shy away from the topic because "it feels scary ... I think it's not knowing the words, not knowing what to say when somebody has died by suicide. What do you say to the family? So there's embarrassment, there's shame, there's an awkwardness."

There's also the fear that talking about suicide might plant the idea in a vulnerable person's head, but "that is a myth," he said from Winnipeg. "In fact, talking about suicide directly to someone actually lowers their risk for suicide.

"It's only by talking about it in an informed way that we can prevent suicides. We need to have those conversations."

With that goal in mind, the association and other groups are mounting a concert Saturday in Ottawa to mark World Suicide Prevention Day. The concert, featuring Canadian singer-songwriter Susan Aglukark and Irish rock band Friends of Emmet, will support local suicide-prevention programs as well as national advocacy organizations.

Scott Chisholm, founder of the Collateral Damage Project and one of the concert organizers, said the event is meant to raise awareness and get people talking openly about the issue.

"People need to understand that it can happen to anybody, any time. Nobody's immune to it and we need to talk about it if we're going to do something about it," Chisholm said from Thunder Bay, Ont. "We need to make it people's issue before it becomes their issue."

Close to 4,000 Canadians die by their own hands each year. Canada's suicide rate, as measured by the World Health Organization, is 15 for every 100,000 people. But the Canadian Mental Health Association says rates are even higher among certain groups, such as youth, the elderly and Aboriginals, with the incidence for males four times higher than that of women.

In Canada, suicide accounts for 16 per cent of deaths for those 16 to 44, says the CMHA. It is the second leading cause of death after accidental injury for 10- to 25-year-olds; 73 per cent of hospital admissions for attempted suicide are among those aged 15 to 44.

Two years ago, Chisholm began collecting the stories and photos of survivors -- the loved ones of people who had taken their own lives. "Collateral Damage: Images of Those Left Behind by Suicide," will be a book of portraits, a website and gallery exhibition.

The project, he said, is a way of coming to terms with his father's suicide at age 47 and a means of counteracting the stigma surrounding the act, which is considered a grave sin by most religions and was a criminal offence in Canada until 1974.

As a 17-year-old high-school student, Chisholm said he was left to grieve and ponder "why" in the isolation born of the hush-hush nature that encircled his father's death.

"My teachers didn't know what to do. They had no tools, they'd never been trained about suicide, and all that they had was their fear and myth and anxiety," recalled Chisholm, one of five siblings. "And with that, they did nothing. So they put up this wall that wouldn't allow me anybody to talk to."

His father had been in and out of the hospital, but the children were told he was being treated for hemorrhoids, recalled Chisholm, who believes his dad was an alcoholic and likely suffered from severe depression.

"But one thing I know, he would do anything for his kids. My feeling is that he thought he was a burden to us and that we'd be better off without him. It's a common theme I hear."

He said one man contacted him to say he had lost his job and had planned to kill himself to avoid being a burden to his four daughters. But a newspaper article he'd read about the emotional devastation experienced by Chisholm's sister, just 11 when their father died, stopped him cold.

The man took it to heart and instead sought help, said Chisholm. "We now can say there's four teenaged girls out there who have no idea about (their father's intention) because we chose to talk about it."

Chisholm said he hopes the Collateral Damage project will give pause to those struggling with depression, other mental health disorders or despair-ridden lives and show them that suicide isn't the only way out -- either for themselves or their families and friends.

"It rips apart families," he said, adding that loved ones are often consumed by guilt over not having recognized the warning signs or failing to get the person help. "It makes us question our relationships, the meaning of them. What is it that could drive somebody to get to that point?"

Aglukark has also experienced the loss of loved ones to suicide, among them three cousins and two close friends.

Healthy Eating Beyond Meat and Potatoes

Preventing Heart Failure — A Serious and Increasingly Common Chronic Disease

ROCHESTER, Minn. — Heart failure happens when the heart can’t pump enough blood to meet the body’s needs. The American Heart Association says heart failure is a growing epidemic. The June issue of Mayo Clinic Health Letter covers some reasons for the increased prevalence of heart failure and options to help prevent it.

Heart failure often develops after the heart has been damaged or weakened by other conditions. The dramatic increase in heart failure coincides with an aging population, more people with heart disease and increased survival rates for those who experience heart attacks.

Over time, a heart that is compromised by underlying disease changes and loses function. The ventricles, the main pumping chambers, may become stiff and not fill properly between beats. The heart muscle may weaken. The ventricles can stretch, decreasing pumping efficiency. High blood pressure, faulty heart valves, abnormal heart rhythms, diabetes and other factors also can contribute to heart failure. Signs and symptoms of heart failure can include shortness of breath and leg swelling.

Medication may be necessary to treat underlying conditions that increase the risk of heart failure. There are many options, including:

- Angiotensin-converting enzyme (ACE) inhibitors — These medications relax the blood vessels to lower blood pressure, improve blood flow and decrease the heart’s workload. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril) and captopril (Capoten).

- Angiotensin II receptor blockers (ARBs) — ARBs offer many of the same benefits as ACE inhibitors and are an option when ACE inhibitors aren’t well tolerated. Options include losartan (Cozaar), valsartan (Diovan) and others.

- Digoxin (Lanoxin) — This medication improves the strength of heart muscle contractions and tends to slow the heartbeat.

- Beta blockers — These drugs slow the heart rate, reduce blood pressure and may reduce the risk of some abnormal heart rhythms. Examples include bisoprolol (Zebeta), carvedilol (Coreg) and metoprolol (Lopressor).

- Diuretics — These medications cause frequent urination, keeping fluids from collecting in the body. Examples include bumetanide (Bumex), furosemide (Lasix) and hydrochlorothiazide.

Adopting a healthier lifestyle can help prevent heart failure. Important lifestyle factors include avoiding tobacco, maintaining a healthy weight, eating a heart-healthy diet, limiting alcohol and staying physically active

Heart failure is a serious chronic disease. The rate of death five years after diagnosis is 50 percent in men and 46 percent in women.

Fall Prevention: Out with the Old Shoes, Old Habits

ROCHESTER, Minn. — The right choice of indoor and outdoor shoes can help keep older adults on their feet, according to the June issue of Mayo Clinic Health Letter. Surveys show that old shoes and old habits can contribute to falls in older adults.

Older adults who wear athletic shoes around the house are much less likely to fall than those who go barefoot, wear socks alone or wear slippers. Outside of the home, older adults often opt for slip-on shoes without snug fasteners or laces. Lace-up or strap-on shoes with a snug fit offer the most support.

Surveys have shown that older adults often wear shoes that are worn out and have lost their cushioning or even have flopping parts. Or, some people persist in wearing shoes that are too small or narrow. Feet tend to elongate with age, and a bigger shoe size may be necessary. Poor-fitting or worn-out shoes increase the risk of falls and can contribute to foot problems such as bunions, corns, or pain under the base of the toe joints (metatarsalgia).

Older adults have many shoe choices, including the traditional rocker bottom shoes with a mostly flat sole and upward curve at the toes. There are many newer trends, including double rocker bottom shoes, foot gloves and shoes with negative heels.

Double rocker bottom shoes feature a sole that curves up at the toes and the heel. The sole looks like the bottom of a rocking chair. They can be effective for people with a fused ankle joint or advanced arthritis of the foot or ankle. Mayo Clinic doctors urge caution with this choice, as they require a level of balance that many older adults don’t have, increasing the risk of falling.

Foot gloves fit the foot like a glove and imitate aspects of going barefoot, but with protection from stepping on sharp objects. Originally designed for runners, they are increasingly popular for casual or around-the-house wear. Again, Mayo Clinic doctors urge caution for older adults. Natural foot cushioning diminishes with age, and it’s possible these products could raise the risk of injury in older adults.

Negative heels feature a heel lower than the toe box. For most people, this shoe design stretches the Achilles tendon more than normal with every step, potentially leading to discomfort and injury. Mayo Clinic doctors say the risk of injury from a negative heel shoe outweighs any potential benefits.

Good shoes that fit well aren’t the only factor in preventing falls, but selecting the right footwear can make a difference.

Healthy and Delicious Eating Beyond Meat and Potatoes

ROCHESTER, Minn. — Fruits, vegetables, whole grains and low-fat dairy should be the star attractions of a healthy diet, with only cameo appearances by meat. A special section in the June issue of Mayo Clinic Health Letter, called “Beyond Meat and Potatoes, The Art of Eating Well,” offers ideas and recipes for an appealing, nourishing diet.

Here are some healthy eating tidbits from the Special Report:

Be a new omnivore: No need to swear off meat altogether. But because of the health risks associated with higher cholesterol and saturated fat, it’s best to limit meat consumption to less than six ounces a day.

Don’t forget the fiber: Dietary fiber, also known as roughage or bulk, includes all parts of plant food that the body can’t digest or absorb. It passes through the digestive tract relatively intact. So why bother? Because fiber aids bowel function (and reduces the risk of hemorrhoids), lowers cholesterol levels, helps regulate blood sugar levels, and helps with weight loss. High-fiber foods generally require more chewing time, giving the body time to register that it’s full.

Savory not salty: Limiting salt can help keep blood pressure under control, which may reduce the risk of heart disease, stroke, congestive heart failure and kidney problems. Instead of reaching for the salt, consider adding dried or chopped fresh herbs to soup, salads or sandwich fillings. Flavor boosters such as garlic, fresh ginger, citrus zest and juices or flavored vinegars can lift foods from flat to interesting.

Pounds and calories: It takes about 3,500 calories above a person’s daily calorie needs to gain a pound of body fat. Likewise, it takes about 3,500 calories under the daily needs to lose a pound of body fat. But a few calories more or less every day start to add up. A person who eats just 100 extra calories a day can gain 10 pounds in one year. Conversely, by eating 100 fewer calories a day, a person can lose 10 pounds in one year.

What’s for dinner? The Special Section features 10 easy-to-prepare recipes that go beyond meat and potatoes. Options include broiled trout with tomato and red onion relish, sugar snap peas with fresh marjoram, spicy beef kabobs, grilled pineapple and fresh mixed berries with ginger sauce.

I’ve never understood the appeal of Christian Lacroix

The screening room at Paramount was nearly full when I got there. Several hundred people had shown up to see Director X’s new film, and more than a few of them were my patients.

A well-known, nympho talent agent was seated near the front, in a low-cut blouse, and she motioned for me come sit beside her. In her lap was a divinely inspired, quilted, black, buttery leather handbag with a detachable cross-body strap and silver ID frame. It could only be Chanel.  My daughter, I thought to myself, would adore that. (My little Meryl is very sophisticated for a four year-old.)

“Charles, darling!” cried the nympho agent, “I heard you were coming. I’m dying to see what this new film is about. I hear it’s a departure from this guy’s standard, commercial fare! I’ve never understood the appeal of this man's films!”

“And I’ve never understood the appeal of Christian Lacroix,” I said, gazing at her shoes.

“What?” said the agent. “Oh, these silly things? I wore them for a lark. Aren’t they too perfect?” She leaned her knees from side to side so that the black satin, vulgarly jeweled shoes would shimmer.

“Three and a half-inch heels and double ankle straps are perfect if you‘re going to the Hookers’ Ball,” I suggested, helpfully.

She set her hand on my knee. “Darling, anywhere I go is the Hookers’ Ball!”

Director X had stepped onstage and was introducing his film. “This movie,” he said, “is a little different from my others. In this film I examine the inner workings of my own mind. And I have to say, I’ve been helped in this process by my acupuncturist and consigliore, Charles.”

Several heads turned toward me and there was a smattering of applause, which I found embarrassing.

“One day,” he continued, “I was feeling very sad, and Charles said these words to me, which I’ll never forget: ‘The only real problem is, you’re a poem.’  A poem! We’ll, I thought about that and..”

A poem? Had I told him he was a poem? I didn’t remember that. But then, I’ve told lots of people they’re a poem. It’s just a thing I say during a session, a handy space filler.

Hello, you’re a poem, how’s your hemorrhoids?

The talent agent nudged me. "Charles, darling,” she said, “you told me I was a poem.”

“I did?” I said, as the lentils stirred in my gut. “Are you sure about that?”

“Of course I’m sure,” she said, sticking out her lower lip. “And I thought that you meant it.”

“Well I did,” I said, suppressing a belch.

“Then how come you told him he’s a poem?”

I was getting nauseous and didn’t feel like arguing.