Almost everyone has a friend or family member who claims to faint whenever they need to get a vaccination or to have a blood sample taken.

Sometimes these individuals are seen as overly squeamish about something that really isn’t very serious. In reality, a lot of people suffer from a phobia of blood, injections and injury. Rather than simply wanting attention, these people have serious, persistent fear and really do faint when exposed to situations where blood, injections or injury are present.

A phobia is defined as an excessive, persistent fear of a situation or object. They are quite common and affect approximately one in 10 Canadians. Usually, the fear is surrounding the anticipated danger or harm that can be caused by the situation or object. This fear is labeled excessive because it is out of proportion to the actual level of danger associated with that situation.

In the case of blood, injection and injury phobias, individuals experience an immediate anxiety response when exposed to even the sight of one of these things on television.

As a result, many people with this phobia avoid all violent or medical-related television shows and movies and often avoid medical treatment as well. This avoidance can be dangerous as individuals with the phobia may put their health at risk by skipping necessary treatments or routine blood tests.

Blood, injection and injury phobias typically begin in early childhood and approximately 75% of people who experience this phobia report a history of fainting in response to the feared situations.

Fainting is a symptom that is uncommon for most phobias so its presence in the case of blood, injection and injury phobias is interesting. It is known as ‘emotional fainting’ and occurs almost as a reflex in the parasympathetic nervous system. In response to the sight of blood or a needle, the heart rate and blood pressure decrease and less blood and oxygen are sent to the brain. Together, these cause a brief loss of consciousness.

All of these symptoms are the opposite of what most phobias induce. Usually there is a heightened response including increased heart rate, higher blood pressure and other effects such as a surge of adrenaline.

It is unknown why the blood, injection and injury phobia spurs the fainting response.

Fortunately, as with all phobias, this one is relatively easy to treat effectively with no medication needed.

Cognitive behaviour therapy (CBT) is used to treat all phobias. The therapy focuses on slowly and safely exposing the individual to the feared situation or object. This exposure based treatment continues and increases until the feared situation no longer provokes feelings of anxiety.

Patients trying to get over their phobia of blood, injections or injury would likely start therapy by being exposed to photos of needles and blood and other feared situations. This indirect exposure would then progress to looking at actual needles and syringes etc.

Usually, to avoid fainting, individuals receiving this therapy will begin exposure while they are lying down. Eventually, exposure will increase to more realistic situations including watching blood being taken until finally the patient has his or her own blood taken.

Along with the guided therapy, patients are encouraged to increase exposure in every day life. For example, people who avoid any television shows or movies with blood or injury might begin to allow themselves to see these things.

Finally, patients with blood, injection and injury phobias are taught ways to avoid fainting. To do this, the individual is taught to tense the major muscle groups such as legs and abdomen in response to the first signs of fainting. By doing this, the patient minimizes the body’s response that leads to a drop in blood pressure.

As is the case with all phobias, it is important to face one’s fears in order to get over them.

If you or a loved one experiences a blood, injection and injury phobia that is causing disturbance in every day living, speak with your doctor about getting treatment.

Two weeks ago I discussed the complexities of driving for those with Attention Deficit Disorder (ADD/ADHD). Today, I would like to return to this condition and talk about the difficulties many ADD/ADHD children and their families face during the summer holidays.

Almost every child looks forward to the summer holidays as a wonderful period of time away from school when time seems to slow down and the beach beckons. However, this unstructured time can be difficult for children with ADD/ADHD and their families.

For these individuals, the routine and structure of the school environment is helpful for symptoms and often makes life more comfortable. Away from the routine, children with ADD/ADHD may feel bored or restless, which can lead to impulsive behaviours.

According to recent surveys, nearly half of parents with ADD/ADHD children said they planned to reduce or stop medication use over the summer holidays even though 80% said the child’s time outside of school is helped with treatment.

Usually, stopping an effective treatment over the summer months is not advised. Unfortunately, for children with ADD/ADHD, school is not the only place they encounter problems because of their disorder.

Although less focus is needed during the summer break, behaviours associated with ADD/ADHD can be frustrating and stressful for the whole family.

Interrupting others, a tendency to be easily bored, short temper, difficulty getting started and finishing tasks, unpredictable moods, impatience and disorganization are a few of the symptoms that can cause problems whether the child is in school or at home.

If the ADD/ADHD behaviour creates no problems at home or with friends, discontinuing medication could be considered. However, in that case, the child may not have ADD/ADHD or may have only a mild case that does not require medication to manage.

Some kids may also want to have a summer job or to be driving – both of which will likely require ongoing medication in order for the child to be successful and safe. Children operating boats, ATVs, motorcycles or any other motorized vehicles are at high risk for injuries if they are not on medication.

Beyond medication use, parents face other issues with ADD/ADHD children out of school for the summer. Fun, structured activities are a good way to help make sure the whole family enjoys this time away from school.

It is important for parents to remember that boredom may make ADD/ADHD children feel restless and irritable. Having activities planned that are enjoyable and useful for building social and life skills is a good idea.

Another tip for a successful summer is to set summer goals. These might include things like: improving school skills learning to play a new sport mastering a new computer program making new friends or improving at a sport or activity the child already enjoys.

Once specific goals are in place, make a specific plan in order to achieve them. Combine structured and unstructured time and give enough variety to keep the child stimulated.

Many children do well in summer camps, which give them a chance to develop social skills away from the family. Choose a camp that will meet your child’s need. If camp is not an option, there are many day programs that focus on specific areas of interest that are both helpful and fun.

Finally, expect that your child will want to have some time simply to ‘hang out’ during the summer. Rest and relaxation are not the enemies. Family vacations, outings such as picnics or movies or simply playing games at home are all good ways to spend time together. Encouraging get-togethers with friends is also good for any child.

Above all, have a safe and enjoyable summer as a family and keep routines as consistent as possible.

A lot of people come to me hoping I can help them in their attempt to leave an unsatisfying work situation and receive disability insurance because of the stress or depression their job is causing.

Unfortunately, disability insurance is not as straight forward as is sometimes thought and is intended only for fairly specific reasons and times away from work.

Since people pay into disability insurance policies for many years, it is often felt that the pay out of that coverage is an entitled right. In reality, insurance does not imply that everyone who contributes will receive a benefit – if that were the case, the cost of insurance coverage would be much higher. Disability insurance is provided to cover absences from work due to unavoidable medical illness or injury.

When a person is unhappy in a job because it is boring or there is a conflict with the employer or other colleagues, it can be depressing and stressful. These are real problems that cause distress and interfere with the enjoyment of life, but in the eyes of the insurance companies, these problems are not cause for disability coverage.

In the case of personal conflicts, the first step should be conflict resolution counseling although in my experience this seldom happens. If the problem is dissatisfaction with the work itself, the best solution is often to look for another job that will better suit the individual’s personality, skills and interests.

If a person in this situation were to stay home from work for these reasons, he or she would be away from work forever. As long as the work remained the same or the same people were there to have conflicts with, the individual would likely feel the same way about returning to work.

Often, people refuse to leave an unsatisfactory job because they know they can’t find one that will pay as well or they may be only a few years from pensionable retirement. These factors can make the decision a tough one but do not justify a disability pension.

In reality, most people today will change their jobs several times over the course of life. In our changing economic times it is important to remain flexible and not become too dependent on a single employer or pension plan. While pensions and job security are great and sometimes very important, it is also important to be satisfied with your occupation. Consider that you spend most of your time at your job.

In other instances, people seek help for treatable conditions but then refuse the recognized best treatment. This is the right of the individual, but does not mean that the insurance company must cover absences from work if available treatment is not accepted.

On the other hand, there are legitimate instances of mental illness that may require absence from work and that can be covered by a disability insurance policy. It is important to understand the coverage you have and to read the policy carefully before purchasing it.

Below are a few tips to help unravel the complicated language of disability insurance.

First of all, it is important to understand what the company’s definition of ‘disability’ really is. Different policies have different ideas on this. There are three common definitions: some refer to a disability as being unable to perform one’s ‘own occupation’ or one’s ‘regular occupation’ others refer to disability as being unable to perform ‘any occupation’ and still other companies refer to ‘total disability’.

With the first type of coverage, if you are unable to do your specific occupation you will get coverage. For example, if you are a surgeon and develop a tremor you will get disability insurance even though you could still perform another occupation. However, if you have an office job and you lose your foot you won’t be covered because you can still do your job.

In the second category, the policy considers you to be disabled only if you are unable to work at any job for which you are qualified by education, training or experience.

Finally, the narrowest definition of all is the ‘total disability’ coverage, which only considers you disabled if you are unable to work at any job whatsoever. Obviously, the quality of coverage varies significantly among the different definitions of disability. It is important that you understand what kind of coverage you are getting.

Being aware of the kind of coverage you have will be useful if you ever need to use your benefits.

In instances of prolonged absence from work, the insurance company will often require an independent medical assessment. The claimant is asked to see a doctor who is hired by the company and has no therapeutic relationship with the patient. This is designed to provide an objective perspective on the injury or illness and the doctor files a report to the company.

In all cases, it is up to the insurance company to decide whether or not to cover a particular disability. Your doctor simply gives a diagnosis, a severity rating and opinions about the cause and prognosis of the problem, but has no say in whether you receive payment or not.

Unfortunately, this issue often comes between patient and doctor when the patient feels entitled to coverage and sees the doctor as the barrier to payment. Remember that your insurance coverage is really not up to your doctor.

Pretty much everyone remembers learning to drive. What exhilarating freedom to get behind the wheel and be the one to decide on the destination and to no longer need parents for chauffeurs! Yes, learning to drive is a memorable time.

Of course, with freedom comes responsibility and driving can be dangerous as well. In fact, of all the potential risks facing young people, nothing is more likely to cause serious injury or death than a motor vehicle accident.

For both teenagers and adults with attention deficit disorder (ADD/ADHD), the risk of accidents is even greater. Studies show that not only do those with the disorder receive more tickets than their non-ADD/ADHD peers, but they are in four times as many accidents and are four times as likely to be at fault.

While a teen with ADD/ADHD may know all the rules of the road, he or she could have difficulty putting them into practice. Performance is what differentiates between those with attention problems and those without.

ADD/ADHD symptoms such as difficulty paying attention, impulsivity, risk-taking tendencies, immature judgment and thrill-seeking can all cause problems for drivers with the disorder. The varying effectiveness of medication throughout the day can be a factor in driving ability.

As with all teens, the risk of accidents increases when other kids are in the car and there are no adults to supervise.

Parents and teenagers should discuss driving privileges together in the general context of their ADD/ADHD treatment plan and set rules and expectations in place for safe driving. Parents may need to understand that extra patience, supervision and time are likely necessary to help ensure the teen develops good perception, judgment and reaction skills.

Other tips for parents with ADD/ADHD children who are learning to drive include: don’t allow your child to drive if you don’t feel safe as a passenger give driving lessons before and after the teen gets a license create consequences for poor driving and observe the teen’s driving skills at different times of the day to determine when medication is most effective.

Some people find that driving contracts between parents and the teen can be effective. These should set out rules and expectations and all terms should be agreed to by both parties.

Increased risk of car crashes doesn’t end once an ADD/ADHD driver reaches adulthood. Follow up studies of adults with the disorder show that poor driving habits continue to be more prevalent in these adults than in the general population.

Necessary skills such as the ability to focus on the road, attention to detail and attention for long periods of time are often areas that are very difficult for people with ADD/ADHD regardless of age. Unfortunately, even becoming distracted for a moment can cause an accident.

If you are being treated with medication for your disorder, taking the prescribed dose regularly is a good way to make sure you are able to focus at your best.

Some other tips to help keep ADD/ADHD drivers safe include:

Keep the cell phone in the trunk while driving. This way you have to stop before using it.

Minimize excessive background noise and music. If music doesn’t bother you, avoid having to change radio stations by using CDs when driving.

Try to avoid driving during rush hour. Heavy traffic can be very distracting.

Plan trips in advance to avoid getting lost or needing to hurry.

Give yourself enough time to get places.

Limit the number of passengers you carry and choose them carefully.

Don’t be afraid not to drive if you think you will be distracted with others in the vehicle.

Never drive when tired.

If you are a driver with ADD/ADHD, following these simple guidelines and your doctor’s treatment advice should help you to be safe on the roads.