HEALTHMAN_By Keith Torkelson MS_UCD Educated Pathology: Ravinder P Singh MD – Assignment – Retroactive 2012 – Boundaries

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Ravinder P Singh MD – Assignment – Retroactive 2012 – Boundaries – By Keith E Torkelson

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Boundaries – Psychotropic's – Sexual Performance and Therapy I – Study (Torkelson, 2018)

Dovetail Off Boundaries – Emotional & Physical Boundaries

Dedicated To

We dedicate this paper to Piper Blush and Jenny Smith AVEY’s mentors.

In Memory Of

Dorothy Stratten (Dorothy Ruth Hoogstraten (February 28, 1960 – August 14, 1980)

Abstract

This report is submitted for partial credit about an assignment Dr. Ravinder P Singh offered up to us back in 2012. The subject for this report is Keith Torkelson a patient of Dr. Singh’s on multiple occasions starting 2006. As of 2018 Dr. Singh is a 2.9 Star or average doctor. This report chronicles Keith Torkelson managing (coping) (with) medication associated impotence. We chart his experiences with Ruth Ligero Tera (RLT) a sex therapist. Keith gives RTL a score of 5.0 Stars for her help with recovering his libido. The model medication we address here is Zoloft. Keith’s Most Significant Other Ever (MSOE) is Joan. Joan had a higher frequency sex cycle than did Keith. We include a section on Rate Your Therapist. The encounters with RLT have had a lasting effect on Keith’s confidence in the face of aging. Keith is now 59. For us the investment of time and money was worth it.

Contents – Tables – Matrices – Figures

Matrix – Objective Up Front (OUF) – Rate Your Doctor (Ravinder P Singh MD)

04_SCR_Singh_Assignment_17092701_Boundry_Evidence

Table – Psychotropic Inventory – Problematic Medications – Context of Sex Cycles

Table – Steps in Pre-planning - Team Tera

Table – Steps in Face-to-face Encounter with ST – A HRE

Table – Session Follow up Activities (ST)

Matrix – Rate Your (Sex) Therapist - Vitals Standard Elements

Table – Rate Your Therapist - Compare Therapists (QGM)

Table – Zoloft - Less serious side effects may include

Table – Pro-Factors for Hands-on Sex Therapy

Table – Con-Factors – Complications (7 Item - Worries and Issues)

Table – Promises – Donovan Promises About Sex (10 Item)

Table – Transactions of Intimacy

Table – Jordan Gray – 7 Item Wants in a Relationship Screener

Table – Other Wants for MSOE (12-Item)

Matrix - Objective Up Front (OUF) – Rate Your Doctor (Ravinder P Singh MD)

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20170714-F:	Responses	CALC	Score	Implied Error Rate
-
Vitals	14	3.3/5	66%	34%
Healthgrades	7	2.0/5	40%	60%

Reweighting		143.3 = 46.2 - 72.0 = 14.0	60.2/21 =
Cumulative	21 Total	Re-CALC	AVG Stars = 2.9 58%	42%

Matrix – Initial Pull from the Internet: 20170824-TH: Doctor Singh’s Ratings Did Not Change – Last Reviewed: 20180518-F:

Interpreting the Error Rates

It is very likely that GOD is near perfect. What professional behaviors lead to poor ratings such as those which 21 clients gave Dr. Singh (RPS)? One element that goes into poor ratings is mistakes. Some mistakes are minor whereas others are major and even life threatening. Back in 2012 (Episode 2012), we suffered catastrophic losses. It is very likely that Dr. Singh contributed. We had thought her to be one of our best Behavioral Health Doctors until we began profiling her. By omission we gather she would say I Dr. RPS is perfect! You just felt that when she was with you for five minutes. You just know she is and has most appropriately serves some of her clients. Dr. Bum Soo Lee a colleague finds her as unremarkable. She has much work to do to get her objective ratings (2.9) up to let us say 4.0 of 5.0 Stars. If we could find anything Online in her favor we would be the first to share it with our inner-world circle via our Blogs.

[HOLD BACK METADATA & QUERYDATA]

04_SCR_Singh_Assignment_17092701_Boundry_Evidence

Actual Scan of Medical Records Dated: 20120425 – Doctor Singh In Charge

Shame On Sign Off (AVEY, 2018)

Sample to compare the writing (Next paper will address the relationship between writing and health). Not that support staff fill out as much of forms as permissible. We have to assume that at least the signature is authentic. We here at MSG do not retain any writing analysts. So I, AVEY, have to try my best. Can you see how hurried that signature looks for signing off. That signature is part of her job. It reflects Dr. Singh’s character as well as motor function. It gets her the big bucks ($200,000 plus per year). Would you let her perform surgery on say your eyeball? How is it a signature? One’s signature reflects that inner workings of one’s mind. Buster AKA Keith has had to re-make his signature several times. One culprit was taking Lithium, which induced Lithium Tremors. Enough said OK: Would you let her drill your teeth? (AVEY, 2018)

Get Rolling on the Assignment (AVEY, 2018)

What it takes to get focused on the matter at hand. We just know that we will help build our boundaries up by discussing Sex Therapy. Our Most Significant Other Ever (MSOE) is Joan (1998-2018). In any given year Joan and Keith were apart for up to half the year. Due to Joan’s problems with dementia we have been apart the longest time ever. Joan had a different Sexual Response Cycle (SRC) than Keith. She desired (needed) sex more frequently than Keith. We have a written testimony that Joan wrote about sex and sexuality. We still are too proper to share it. Joan was insatiable. Combine SRC issues & separations with Drug Induced Impotence (DII) and in comes the need to retain a Sex Therapist. Oh! Who are we – we “B” MSG.

Pharmacological Agents Causing Sexual Dysfunction - Taylor & Francis Online (1977)

https://www.tandfonline.com/doi/abs/10.1080/00926237708402981?journalCode=usmt20

By RT Segraves

“Reports of pharmacological agents affecting the human sexual response cycle are critically reviewed. Because of the paucity of adequately designed studies, few definitive statements can be made about pharmacological effects on human sexual functioning. Tentative evidence suggests that drugs with side effects of adrenergic blockade are associated with ejaculatory disturbances. Impotence appears to be associated with drugs possessing significant anticholinergic activity. Drug induced impotence and retarded ejaculation could both also be related to central dopamine blockade.”

Table – Psychotropic Inventory – Problematic Medications – Context of Sex Cycles

Defining The Problem - Anticholinergic Activity Drugs

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Drug	Ever Taken	Result Issues
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Parkinson's medications
-
Diphenhydramine (Benadryl)	X	Intolerable
Trihexyphenidyl (Artane)
Benztropine mesylate (Cogentin)	X	OK
-
Antipsychotics

Chlorpromazine (Thorazine- Discontinued brand)
Clozapine (Clozaril, Fazaclo ODT, Versacloz)	X	Tolerable
Fluphenazine (Prolixin- Discontinued brand)	X
Olanzapine (Zyprexa, Symbyax)	X	OK
Pimozide (Orap)
Quetiapine (Seroquel)	X	Tolerable
Thiothixene (Navane-Discontinued brand)	X	Terrible Medication
Trifluoperazine (Stelazine-Discontinued brand)
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Table – Psychotropic Inventory – Problematic Medications – Context of Sex Cycles

Reference

https://www.medicinenet.com/anticholinergics-antispasmodics-oral/article.htm

On Discontinued Brands – Drugs in Development

We do not have the resources to flesh about the discontinued brands. Just let it be known one of them Navane is on our list of the five (5) worst medications of all time. See if Pfizer the manufacturer had discontinued it earlier we would have been spared the suffering associated with Navane. Think about this: Why are they developing new drugs. If the current medications (psychotropics) in the arsenal were effective and work well why fix them? OK! Let it be said that some of the medications above we personally associate with Drug Induced Impotence (DII). Dr. Dobos (Kaiser) said that it wasn’t usual for a male our age to loose his “Sex Drive”. Later we will address Zoloft a bit. Let’s us get on with how Keith coped with this presenting problem. Enter Ruth Ligero Tera (RLT - Private Sex Therapist).

Table – Steps in Pre-planning - Team Tera

Failure Session – Success Session

Ruth Ligero Tera (RLT - Private Sex Therapist)

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Step		Note
-
Pertinent History		Presenting Problem
MSOE Position		Separated
Referral		Friend – Charles Anderson
Planning		The first appointment is the most difficult
Budgeting – Fee for Service Sliding Scale
Security Issues
Performance Outcomes		Came in with issues Left with Solutions
Transportation & Venue
Appointment Time
Appropriate Dress
-

Table – Steps in Pre-planning - Team Tera – Last Reviewed: 20180518-F:

Details Not Important

It is easy to fill in the blanks. We were so debilitated (moribund) that our first session resulted in a failure.

Table - Steps in Face-to-face Encounter with ST – A HRE

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Step		Note
-
Small Talk
Establish Rapport
Trust Agreement
Cognitive Behavioral Therapy		Positive thinking
Availability (Referral to Colleague PRN)
Negotiate Sliding Fee Schedule
Goals – Time Limited		2-3 session per medication
Petting
Private Office
Boundary Agreement		No kissing
Treatment Facility		We have seen better
Imagery Agreement
Option to Shower
Policy – Minimize Exposure to Risks in Scope
Photographs to Remember Session
Satisfaction - Failure Guarantee
Homework Assigned Recall with Photos
Protection		Risk prophylactic failure
-

Table – Session Activities & Elements - Steps in Face-to-face Encounter with ST – A Health Related Engagement (HRE): Last Updated: 20180519-SAT:

HRE=Health Related Engagement

Table – Session Follow up Activities (ST)

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Step		Note
-
Satisfaction Survey (Overall) – Vitals Brief		5.0 Stars of 5.0 Stars all sessions
Food – First Notion After
Home Safe
Doctor Examination – Everett Gee (Kaiser PCP)		Prophylactic Failure Event Lived Experience – Very Low Frequency
Test Results		Positive Control for Stress
Accountings – Cost & Benefits
MSOE Performance		Positive for performance
Graduation – If/Then
-

Table – Session Follow up Activities – Last Reviewed: 20180518-F:

Clozapine

We have never had to retain a sex therapist since Dr. Singh put us on Clozapine back in 2006.

Matrix – Rate Your (Sex) Therapist - Vitals Standard Elements

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Item #	Patient Ratings Service Element		Ruth Ligero Tera (RLT - Private Sex Therapist)	Sample CALC
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01	Ease of Appointment		1.0	1.0
02	Promptness		1.0	1.0
03	Courteous Staff		1.0	1.0
04	Accurate Diagnosis		1.0	X
05	Bedside Manner		1.0	1.0
06	Spends Time w Me		1.0	0.5
07	Follows Up After Visit		1.0	X
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	Items = 7 (MAX)	Encounter Satisfaction Score =	7.0/7 100% (5.0 Stars)	Sum/#Scored 5.0/5*100
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Matrix - Vitals Method - Date Scored 20180515-TU: Indications of Satisfaction: Actual Data from 2 Encounters Date of Service – Last Reviewed: 20180518-F:

Dates of Service

The dates of service may be adjusted when and if we fish the records out of our archives.
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Subject Profile (Brief)

This report discusses the Lived Experiences of Keith Torkelson (AKA Buster). The presenting problems were impotence most likely caused by a combination of stress and ingestion of psychotropic medications. We call this chemical impotence and stress impotence.

Table – Rate Your Therapist - Compare Therapists (QGM)

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Resource	Quick Grade	Points	Addressing
-
Sharm	A	4	Childhood Trauma
Kaiser – Grief	A	4	Mom Dying
LaTonya Tingstad	A	4	WorkAbility Consumer Case Management
Ruth Ligero Tera	A	4	Confidence with Intimacy Chemical Impotence
Joyce Brown	A	4	Family Therapy

AP Deutsch MD	B	3	Mind Issues with Medication Management
Laura Adams	C	2	Family Issues
Kaiser – Routine	C	2	Depression
First Psychologist	C	2	Coping with Catastrophic Losses (1988-1989)
-
Average Performance =	B	3.2	Cohort Grade Point Average
-

Table – Rate Your Therapist – Quick Grade Method (QGM) – Date Scored: 20180518-F

QGM=Quick Grade Method

GPA=Grade Point Average

Cohort GPA

Drill Down on a Medication – Zoloft
It is really hard to stay focused when you see side effect lists. For our purposes here we are skipping serious side effects for which you are advised to call your doctor. What follows is a fairly representative list of less serious side effects. It is interesting that sex problems are not considered serious.

Table – Zoloft - Less serious side effects may include

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Less serious side effect	In Scope	Ever
-
Changes in appetite or weight		+
Constipation
Decreased sex drive	Here	+
Difficulty having an orgasm	Here	+
Dizziness		+
Drowsiness		0:)
Dry mouth		+
Impotence	Here	+
Mild nausea
Sleep problems (insomnia)		+
Stomach pain
Tired feeling		+
Upset stomach
-

Table – Zoloft - Less serious side effects may include – Last Reviewed: 20180518-F:

FYI – “This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.”

Zoloft (Sertraline HCL) Patient Information: Side Effects and Drug

Reference

https://www.rxlist.com/zoloft-drug/patient-images-side-effects.htm

Walk Down Memory Lane

Every time we address a side effect list our thinking migrates about how many psychotropic experiments we have agreed to and paid for. The Zoloft experiment was one of the less costly trials. We proved it was interfering with work, school, intimacy, etc. very quickly.

Table - Pro-Factors for Hands-on Sex Therapy

-
	ST-Parameters	200 (?)	2007
-
	Blood Tests	Normal	Elevated WBCs
	General Good Health	No	Better
	Number of Sessions	2 Minimum	None
	Physical Exam	NA	NA
	Practical Exercises	Yes	Yes
	Sexual Communication Skills	Good	Yes
	Targeted Assignments	Yes	None
	Touching Exercises	Yes	Yes
-

Table - Pro-Factors for Hands-on Sex Therapy: Date Scored: 20180518-F:

Table – Con-Factors – Complications (7 Item - Worries and Issues)

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#	ST-Parameters	2000	2007

1	Boundary Issues	SoSo	SoSo
2	Chemical Impotence	Yes	SoSo
3	Financial Worries	Yes	Yes
4	Legal Worries	No	SoSo
5	Relationship Conflict	Yes	SoSo
6	Stress Related ED	Yes	Yes
7	Work Worries	Yes	Yes
-

Table – The Complications with Hands’ On Sex Therapy: Date Scored: 20180519-SAT:

ST=Sex Therapy

ED=Erectile Dysfunction

Table - Promises – Donovan Promises About Sex (10 Item)

-
#	Promises	AMSOE	About Self
	-
01	DHEA Spike	UKN	OK
	Exercise	Yes	Yes
	Heavy Breathing	Yes	OK
	Hormones	OK	OK
05	Lowered Cholesterol	UKN	No
-
06	Oxytocin Secretion	UKN	UKN
	Pain Relief	Yes	Yes
	Prostate Protection	NA	Yes
	Protect Your Heart	Yes	OK
10	Stress Relief	OK	Yes
-

Table - Promises – Donovan Promises About Sex (10 Item): Last Reviewed: 20180519-SAT:

AMSOE=About Most Significant Other Ever

DHEA= Dehydroepiandrosterone

FYI - Reference

blog-ilmukita.blogspot.com: A healthy sex life: 10 reasons to make love

http://blog-ilmukita.blogspot.com/2008/12/healthy-sex-life-10-reasons-to-make.html

A healthy sex life: 10 reasons to make love…states Donahey...by Deb Donovan

FAQ – Have we had and are we having a healthy sex life?

Testosterone Slavery

Back in 1989 we worked as a lab associate for Hospital Pathologist Central Laboratory. It was routine procedure for the staff to run any test they wished in due course of a week. Our associates predicted that we would have elevated testosterone based on our pattern balding. They ran it and they were correct. For us testosterone is not only cyclical it is highly detectable at elevated levels. Elevated testosterone can be uncomfortable. We think it can even impair your judgment. We haven’t detected this uncomfortable feeling since we turned 53 in 2012. It looks like we traded performance for comfort.
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Table – Transactions of Intimacy

-
##	Feature	WFIHS	WMSOE
-
01	(Hetero) sexual relationships	1.00	1.00
02	Emotion	1.00	0.50
03	Gender relations	1.00	1.00
04	Heterosexual intimacy	0.25	1.00
05	Maximize quality of life	0.50	0.75
-
06	Minimize sexual dysfunction	0.00	0.75
07	Mutually loving sex	0.00	1.00
08	Quality of life	0.50	1.00
09	Relationship satisfaction	0.50	0.25
10	Sexual satisfaction	0.00	1.00
-
11	Sexuality	0.00	1.00
12	Transaction of intimacy	0.25	1.00
-
	Intimate Transaction Value (ITV%) =	5.00/12 41.7%	10.25/12 85.4%
-

Table – Transactions of Intimacy – Date Scored: 20180518-F: Last Reviewed: 20180518-F:

WFIHS=With Females In Hospital Setting

WMSOE=With Most Significant Other Ever

FYI - Reference

Sexual satisfaction, quality of life and the transaction of intimacy in hospital patients’ accounts of their (hetero)sexual relationships Gavin Daker-White and Jenny Donovan (2002 - 25 Pages)

https://www.onlinelibrary.wiley.com/doi/10.1111/1467-9566.00005/pdf

Sociology of Health & Illness Vol. 24 No. 1 2002 ISSN 0141–9889, pp. 89–113

Hospital Patients - Sex

We have been in the Behavioral Health Ward (BHW) on more than one occasion. When we talk with females about sex on the ward many report they had sex while in lock down. For example some of the females report at least one intimate experience in Norwalk State Hospital. Our male colleagues are either keeping secrets or never had sex while locked down. You know how there are reports of professionals such as teachers having sex with those they help. We feel there may be a chance for Staff Involvement. There was this TV show called Women in Prison. It was an “American television sitcom created by Katherine Green which aired on Fox from October 11, 1987 to February 20, 1988”. One of the females hooked up regularly with the maintenance male. They usually did it in a crawlspace in the ceiling that was only accessible with a ladder.
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Table – Jordan Gray – 7 Item Wants in a Relationship Screener

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Wants - Cravings	Target Family	Target MSOE	Satisfied
-
Praise and Approval	Yes		Yes
Respect			DNM
A Sense Of Sexual Connection		Yes	Yes
Emotional Intimacy		Yes	Yes
Space	Yes	SoSo	SoSo
Physical Touch	(***)	Yes	Yes
Security	Yes		SoSo
-

Table – Gray 7-Item Relationship Screener – Last Reviewed: 20180518-F:

DNM=Does Not Matter

MSOE=Most Significant Other Ever (1998-2018)

-
(***) – We had physical touch issues with our older brother (Born 1949). On a routine basis our older brother hurt our sister (Born 1955) and us. Keith’s response to his behavior most likely contributed to Keith’s gradually becoming an Untouchable. In 1995 Jodi Rombotis successfully addressed our un-touchable nature. She said kiss me!

Reference

7 Things Men Want In A Relationship - The Good Men Project (Jordan Gray, Sep 2, 2014)

https://goodmenproject.com/featured-content/7-things-men-want-in-a-relationship-jgc/

Table - Other Wants for MSOE (12-Item)

-
Our Want (Need)		Note
-
Adventures		Usually road trips
Communicate Needs		Didn’t go over well
Exploring
Help in Emergencies
Kissing		Kissing is like cool!
Love		Periodic
Mission Respected		Teaching didn’t go over well
Nature Intelligence
Path Respected
Sharing and Enjoying Food		More wonderful than not
Time Spent		Never quite enough We said Less can be More
Wake up in bed together		Satisfied – Very important criterion
-
More
-

Table - Other Wants for MSOE (12-Item) - Last Reviewed: 20180518-F:

DNM=Does Not Matter

MSOE=Most Significant Other Ever (1998-2018)

Conclusion and Closure

Erectile Dysfunction Sex Therapy: How It Works, Insurance, and More

https://www.webmd.com/erectile-dysfunction/guide/sex-therapy-erectile-dysfunction

Sex Therapy for Erectile Dysfunction

Does Sex Therapy Work?

“Sex therapy is most effective when a man's sexual partner is willing to be part of the treatment. Studies have shown that for men with stress-related ED, having the partner involved in the therapy resolves the problem 50%-70% of the time. When the man must go through counseling alone, the results are somewhat lower.”

Yes – Sex Therapy Worked!

This is the End

Image Gallery @ The End