Calling Bluffs and Behavioral Modification in the nest of Teen Developement

A new problem in the Post Office area that I thought was going to be v4, maybe more like v7/8.

My last rotation was at the "Youth Service Center" i.e jail in Greeley. One issue stood strong as a point of contention and made this rotation quite challenging. Obviously all the kids in prison have done some wrong but I'm of the opinion that this should not change the level of willingness we have for treating these teens as youth who make mistakes/bad choices and ultimately need to be treated in a certain manner that will encourage proper development.

Many of these kids come to the clinic with concerns that make you question the motives behind the complaints and their veracity, i.e "I'm puking blood, I have Ebola, my foot is broken, I'm dying, I think I have cancer, etc." It's so easy to blow off the complaints as psycho-somatic or malingering but what I got to thinking about was something on the next level: even if the complaints are not grounded in real medical issues, how do we best treat these kids medically and behaviorally?

I had a patient with a chief complaint of "broken neck," really he had torticollis like the hamster below.

Man... why can't I do the last move on Gorillas!!? Kept falling off the last move early this season so I stopped going up to try it, got frustrated. The last 2 weekends I've gone up and tried the move a million different ways, got the JJ dispatch on the intricacies and a rejuvenated psych, and I think I'm goin' to combine some tech-magic with some raw thuggery and icy temps later this month, mo-fro is going down. Evans is gorgeous now, white peaks, golden valley, aspens changing, red plants jumping out here and there, breeze that smells of snow and decay.

Most of the time the kid is in a position of knowing that he is mistrusted and having to prove him/herself. Though this may make sense given a history of manipulation and crying wolf is it not possible that by instead showing trust and care we encourage proper behavior and by distrust we may be perpetuating the game the child has learned to play so very well?

Though I don't have the exact articles at hand, during my previous life in psychology I read a few papers that were showing how behavioral modification and token economies were less effective in teens as compared to pre-teens. In our teens we fully develop the capacity for abstract thought and in turn start to develop or own personal philosophy along with a sharpening of our capacity and desire for reason and growth spurt in the pre-frontal cortex. What better time to set examples for youth struggling with choices; instilling a philosophy as opposed to perpetuating a complex gaming.

Stacked on top of this issue is the question of treating behavioral issues pharmacologically in teens. How much of psychiatry is an aid to the child and his/her development and how much is an aid to the caregivers in controlling difficult behavior? Don't get me wrong, I am a strong proponent of psychiatry and have seen many cases in my career that were irreparable without pharmacotherapy but the the question of snowing a kid with antipsychotics as a means of anger management should bother those who are concerned with the long term outcomes of abnormal or inadequate development of coping skills, self soothing, life skills, confidence, and an internal locus of control.

Now I'm back from Greeley, working in the ED wondering where to go with these thoughts, wondering how to find time to answer these questions. 5 weeks and I'm off to Vail.

Greeley Wildlife:

Below it Ted Lanzano on the 13b Jump at the Industrial Wall, but really he was doing "Chump 13a" (the low start has been done by Andy Raether at 13c called Jew Don't Wana Go There) 'cause he was being a wus and not doing the jump part. I was still nursing a bum knee and tried/got served on Terminal 13a 'cause I couldn't bend my right knee.

During my month in Greeley I drove the 45 minutes to Carter twice a week and would climb for about an hour and a half before the sun disappeared and my body called it quits. I had a fun circuit going with a number of v5's and some pumpy traverses and a few easy high balls; I'd never been that psyched on Carter but my nose for the place developed. There's a new boulder at Carter Lake thanks to the low tide, or at least I think it's new, it is under the Kahuna Roof by a stone's throw. Here are two problems I did one night. The first v5/6, the other v2/3ish but quality, nice setting, quiet, walk home on the beach in darkness bathed in sore bones, sometimes jump in water speckled with pink and orange and watch ripples.

Digesting Big Spurious Perms

Something about Greeley has made me question my identity lately, or maybe its the fact that I'm not coaching or setting, not going to dance classes, not sitting at the Shambhala Center, as was the life of old, but maybe it's the rows of corn and the milky mid-west skies that seem to pester me in a sort of Devotcha-Megadeath-Sigur Ros tone: "do you speak in tides or grains or sand," and when pressed I think the answer is more of solid state.

I spent the last month of my summer in Inpatient Medicine at Denver Health. Before showing up my first day I wasn’t sure if I was going to be getting my hands dirty doing colonoscopies, discussing constipation, or dealing pain drugs to those of chronic need and disability. In short, this was one of those rotation that I was a bit anxious about: 1 because internal med involves loads of labs and labs, to date, are not my strength but also; 2 because there is so much to learn from inpatient medicine that I felt like I had to take a deep breath before diving into this tome of practice.

Below is Sock Hands on a pile of an boody-dragger problem that almost tore my LCL.
My experience was top notch, in fact one of my favorite rotations so far. The patient volume was low but there was a huge emphasis on detail and understanding the patient and his/her labs through and through, being able to confidently explain the differential and make a diagnosis. I saw a million chest pain patients, worked on my spanish with the “emergent” dialysis patients, saw a crippling gout attack, saw a 36 year old women with alcoholic neuropathy and osteomyelitis of 3 of her toes that required amputation... and I got my first wif of Clostridium Difficile in the ED. Last, my attending at DH for the last 2 months were so inspiring I continue to ask my self if I may want to go down the MD path.

In the meantime I finished up on Resonator (13a... the contrived but cooler way), the Orb13b but maybe a/b if one uses a rubber knee as I did, or two as others have done, and Mirror Mask (v10, not v11 as it has been called),

made a trip to independence pass (see www.independencebouldering.com for Greg's work towards developing the rock up there) with Brent, Terra, Clink and Katie Whipple who took a big fall on her bum, tough girl, shook it off and got on the most amazing 11a I’ve ever been on; pumpy, amazing holds, slopers, slab, heal hooks, dyno, jugs, perfect, and at 11a called Baba Fats,

"Well, that is that," says Baba Fats, sitting back down on his stone, Facing another thousand years of talking to God, alone. "Yes, Lord, it's always the same...old men or bright-eyed youth... It's always easier to sell 'em some shit than it is to tell them the truth."

Shel Silverstein

I’ll post on the Greeley experience and working in youth corrections next. Climbing goals for this fall are limited but I want to get back up to Tiempos de Ciegas (13c) in Boulder Canyon and wrap that up. I also want to finish Gorillas (v10/11) in area B at Evans. That’s would wrap up a darn fine season and send me off to Vail in style.

Below is a little thing that I climbed above Dave Grahm’s Big Worm, I’m calling it Big Perm, V4 (probably done already but if not... call it Big Perm V4)...8 in-cut crimps up slightly overhanging rock to slopey top out, but if you’re climbing v4, climbing this thing would be down right foolish, falling from the top moves, the crux, would break something... and you know this. I scrubbed and did all the moves on the problem to the left of Big Perm but couldn’t commit up high, the crux is up high and off balance on this thing, big supper cool and about v5 over all, start in the underclings and go up.