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Rent vs. buy in Charleston, S.C.: Which is right for you?

The following blog was written for an online real estate company that connects home buyers and sellers to agents in their market.

Moving to beautiful Charleston, South Carolina, may be an easy decision, but deciding whether you should rent or buy a home once you get there will require extra thought. There are a lot of factors to consider, including your personal priorities, financial situation, future plans and the state of the housing market.

Questions to ask yourself when deciding which option is right for you include:

  • How long do I plan to live there?
  • How much money can I afford to pay out of pocket?
  • Are there any family or job circumstances that may require me to quickly pack up and leave?
  • How close do I want to live to the center of the city?
  • Is customizing my home important to me?

In general, renting allows you more flexibility if you’re not looking for a long-term arrangement or if you’re unsure of what your future holds. Contracts vary and can often be signed month to month or renewed yearly. If your plans change, you can pack up and move without having to worry about selling a home.

Renting also requires less money up front, so if you’re concerned about immediate costs, renting may be more accessible than buying.

Let’s take a deeper dive into the factors that should come into play as you weigh which option is best for you.

Understanding the housing market

Charleston is known for having a consistently competitive housing market, meaning homes often don’t stay available for long. In fact, the average home is only listed for around 60 days, and “hot homes” — or homes that are expected to be the most competitive ones on the market — are typically under contract in around 42 days¹.

Due to this demand, prices are increasing over time, which could be a good or a bad thing depending on your situation. Higher prices may make your dream home out of the question, but homes increasing in value also makes buying a good investment, as those increases could turn into extra pocket change when you go to sell your home.

A competitive market also means that multiple buyers may put in an offer on the same house, which could cause the house to sell for more than it was originally listed. That’s where working with a seasoned, local realtor can be helpful, as you want to make sure you aren’t spending more than the house is worth.

Current home prices in Charleston

The current average sale price of a home in Charleston is around $375,000¹, which is relatively high when considering that the average list price for a home in the U.S. last month was $340,000². However, as with most major cities, the prices of homes vary depending on how close you live to the heart of downtown.

If you’re willing to take a 20-minute highway drive to get to the city’s core, then the area of Hanahan, which is slightly northwest of downtown Charleston, may be worth a look. The current average sale price for a house in Hanahan rings in at slightly under $323,000³, making it about $52,000 cheaper on average than buying a home in the Charleston city limits.

Prices in Charleston have increased 11.9%¹ since this time last year. The average home sells for about 2% under list price, including in areas like Hanahan, which means you should expect to pay close to the listing price if you want your offer to succeed. 

Homes receive an average of two offers, and 17.6% of homes are selling for more than their listing price.

Weighing your upfront costs

Moving is expensive regardless of whether you choose to rent or buy, but it’s important to understand exactly what you’ll be paying in exchange for the keys to help determine what you can afford.

Upfront costs of buyingUpfront costs of renting
Down payment (typically falls between 3% and 20% of the price of the home)Security deposit (typically equal to one month’s rent)
Property taxesFirst month’s rent
Insurance costsLast month’s rent (this is often required upfront, but not always)
Maintenance costsPet fees
Moving costsMoving costs
Utilities/activation feesUtilities/activation fees

Costs unique to buyers

Buying a home requires more money spent out of pocket, largely due to the down payment. Most loans require you to pay at least 20% of the sale price to avoid having to pay additional money for mortgage insurance, which protects the lender if you can’t afford your payments. Mortgage insurance costs typically range from 0.5% to 1.5% of the price of the loan.

If you bought a home at the median sale price of $375,000, a 20% down payment would be $75,000.

Home buying also comes with extra expenses that don’t apply to renters, including property taxes, any fees required by homeowner’s associations, and homeowner’s insurance. Luckily, South Carolina property taxes are low compared to the rest of the country, and they sit even lower in Charleston County at just 0.47%.

Because most areas in Charleston are prone to flooding, flood insurance is often required and can be expensive depending on the level of risk. Prices are based on which zone you’re in, as determined by the Federal Emergency Management Agency.

Buyers can also expect to shell out additional cash for initial maintenance and repairs to the home that the seller doesn’t agree to cover. Common maintenance items following a move include having the locks changed on your doors and replacing air and water filters.

Costs unique to renters

Renters may get out of paying homeowner’s insurance, but they’ll still need to pay renter’s insurance to protect the value of their belongings. Luckily, this only adds up to an average of about $15 per month.

For renters who plan to bring along their furry friends, many landlords require a one-time pet fee or monthly pet rent, which often equals several hundred dollars for a year-long lease.

Costs shared by buyers and renters

For both buying and renting, you’ll also want to factor in moving costs, such as renting a truck, hiring movers and paying for supplies such as boxes and packing paper. Costs will often be much higher if you’re moving across the country as opposed to an in-town move.

Monthly utility payments for things like internet, electricity, water, sewage and trash services also often apply to both renters and buyers, though utility costs are occasionally covered in a rental agreement. Some service providers charge an activation fee to begin service, and trash companies may charge a fee to drop off your bins.

Renting in Charleston

The average rent price in Charleston is currently hovering slightly above $1,400 per month, meaning you can expect to pay more than $17,000 over the course of a yearly lease.

While renting may cost less upfront, the monthly payments you make to your landlord disappear the second you hand them over. The money isn’t going toward owning your home, so you won’t be getting any money back when you leave except for your security deposit.

Renting has its benefits and drawbacks, as it can allow you to change locations more easily but can also restrict your freedom. Landlords may impose rules that limit things like the number of occupants who can live in the home or how long visitors can sleep on your couch.

Pros of rentingCons of renting
Short-term contracts can help you decide if you like the city or neighborhood before committing long term.You can’t make aesthetic or structural changes to the home, and you often can’t even put nails in the walls.
When something breaks or storms cause damage to your residence, maintenance and repair costs are covered by your landlord.Contracts can be strict, and the downfall of forgetting a rule can be costly during your move-out inspection.
The process is simpler — you won’t have to deal with loads of paperwork and negotiations with a seller.You have no control over the fate of the home and could be forced to move if the home is sold or if the rent price rises beyond your budget.

Another less obvious thing to consider before renting a home is whether your furniture will fit in the space or clash with the wall colors. If your existing furniture won’t work, you may have costs associated with buying new items or renting a storage unit where you can keep your extra belongings.

Buying in Charleston

While buying a home can be costly and risky since the value of your home may not always increase, being a homeowner also comes with its perks, including more freedom to make your space feel like home.

Pros of buyingCons of buying
You can work with a realtor (free of charge!), who can help you find exactly what you’re looking for.The next time you want to move, you’ll have to buy and sell a home at the same time.
You have the opportunity to build wealth as your home’s value rises.If you decide you don’t like your neighbors, commute or area of town, it will be trickier and likely more expensive to leave than if you were renting.
You have control over which companies tackle your maintenance projects, so you can ensure they’re done well and on time.You may need to live in the home longer than you’d like to ensure you turn a profit or break even.

Pride in homeownership is also real, and you’re more likely to form connections with your neighbors and your community when you’re financially and emotionally invested. 

Plus, you can make all the changes to your home that you want, so you have an excuse to explore the deepest corners of Pinterest and binge HGTV remodeling shows.

The bottom line

Renting and buying both come with their own set of advantages and disadvantages, and making the right decision for you in your current stage of life will ultimately come down to your goals and your financial comfort level. 

If you decide to buy, we recommend connecting with a local real estate agent who can help you navigate current trends in the market, direct you toward neighborhoods that fit your lifestyle and empower you with the knowledge you need to make informed decisions.

Citations:

¹ https://www.redfin.com/city/3478/SC/Charleston/housing-market 

² https://www.realtor.com/research/december-2020-data/ 

³ https://www.redfin.com/city/8198/SC/Hanahan/housing-market 

Lessons learned from HIV and a diagnosis of COVID-19

The following feature was written for the Infectious Diseases Society of America (IDSA) Foundation’s 2020 annual report, for which I served as editor. View the full report.

The first role infectious diseases specialist Michael Saag, MD, FIDSA, played in the COVID-19 pandemic was that of a patient.  

He had just arrived home in Alabama after a 20-hour car ride from New York City with his son, Harry, on March 12, 2020, when Harry spiked a fever. Within days, Dr. Saag also developed symptoms, and he and Harry both tested positive for COVID-19. 

Over the next two weeks, Dr. Saag battled symptoms that quickly progressed from mild to more severe, including a high fever, profound muscle aches, loss of appetite and an inability to concentrate. At 64, he was concerned for his safety, with fears of being hospitalized and placed on a ventilator. 

Once he overcame his illness, he didn’t waste any time putting his personal experience and expertise to work for the benefit of those around him. He took his work beyond clinical walls by diving into advocacy, research, public health education, policy advice and volunteerism.

Backed by decades of experience in the field of ID, Dr. Saag attributes all of the passion and direction that guided his response to COVID-19 to the patients he treated during the HIV pandemic in the 1980s. These patients, whom he refers to as the “heroes of the era,” taught him three things: 

  1. If you get a disease like HIV or COVID-19, you should go public with your story. 
  2. Participate in research. 
  3. Get involved in policy, and make a difference as best you can by sitting at the table. 

“The day of my diagnosis, I stuck my arm out and said, ‘Draw blood,’” recalled Dr. Saag. “I volunteered as a research subject as soon as I was infected. Two months later, I had a central catheter line placed and donated 500 cubic centimeters of plasma and billions of cells. I’ve been on a data safety monitoring board for a large national study for treatment of people in the ICU not because I’m a scientist, investigator and physician – I’m the patient representative.” 

In April 2020, he published an op-ed in the Washington Post about his experience battling the disease with a stark warning about the threat the virus posed: “This will not be the last time a virus skips from animal to human. It should be the last time we are so unprepared.” 

But Dr. Saag’s work didn’t end with his personal recovery. As a researcher, he led numerous studies looking at outcomes among people living with HIV who developed COVID-19. In patient care, he volunteered to serve in the COVID-19 outpatient clinic at the University of Alabama at Birmingham, where he helped to establish a monoclonal antibody clinic to reduce the severity and duration of illness in patients who met certain criteria. 

In local service, he spearheaded a testing campaign for all 280,000 students in the state of Alabama who were returning to colleges and universities. In just six weeks, the team created from scratch a platform and process that tested around 200,000 students within 10 days before they got back to campus or as they arrived back on campus. This effort included managing logistics such as lab capacity to manage 6,000-8,000 samples per day; ensuring the results were returned to the student, college and state; having people at each college to conduct testing; and tracking all samples through transport back to Birmingham. 

Despite all of these efforts, he still had time to educate the masses through local and national media interviews, assist with vaccine distribution and see patients in the hospital on consult – all while maintaining his regular day-to-day responsibilities. 

“I find all of that service and activity to be a bit of silver lining in a very clouded, horrific experience. Rather than sitting back as a spectator, I’m actively participating in the response and getting engaged in ways where I’m in a position to become engaged,” said Dr. Saag. “ID doctors are called to serve as unpaid consultants to all of these entities to help people respond in the most appropriate way. I can’t think of a single ID doctor who hasn’t stepped forward like I have. It’s like a call to battle.” 

As he reflects on the parallels between COVID-19 and HIV, he notes the differences in timelines. It took two years to uncover the cause of AIDS after the CDC released its initial report in 1981, and a test wasn’t released until 1985. The first treatment was released in 1987, and 40 years later, there still isn’t a vaccine. 

In contrast, a candidate vaccine for COVID-19 was developed just two days after the virus’ identification and sequence was released on Jan. 10, 2020. The first drug was released within months, and vaccine results in 40,000 people were analyzed and released in less than a year. By April of 2021, vaccine production had outpaced demand. 

“I would argue strongly that the fundamental reason we were able to do so much so fast with COVID is grounded in HIV research that goes back four decades. It’s not only HIV, of course, but the nature of how to do clinical trials well, quickly and efficiently without being in a hurry, and the nature of understanding virology, how viruses replicate and how you interfere with that replication,” said Dr. Saag.  

From a science standpoint, he believes we’ll be even better prepared for the next pandemic, noting that the place where we’re still lacking is in unity when it comes to a national response. 

As the field of ID continues to hold the global spotlight, Dr. Saag believes it’s more important now than ever to support ID specialists and to ensure we’re replacing the highly experienced professionals who are retiring daily. 

“If there was ever any question about the value of an ID doctor, that has been put to bed. I think now the question is how we can meet the need in the future, because right now, there is a shortage of ID professionals,” said Dr. Saag. “That shortage will only grow unless we proactively respond and prepare programs to train more people and support them.” 

Experts offer six tips for lowering cancer risk through lifestyle choices

The following blog post was originally posted on MUSC Hollings Cancer Center’s website. View the original post here.

More than 40% of cancer cases and cancer deaths in the United States are linked to modifiable risk factors, meaning they could be prevented, according to the American Cancer Society. That means more than a third of what causes cancer is more within our control than some might have realized.

Many factors can play a role in an individual’s personal risk for cancer, including family history, certain hormones and age, but increasing evidence shows that lifestyle choices can have a profound impact on cancer risk and outcomes. Certain diets, activity level, sun exposure, body weight and alcohol use have all been identified as factors that can increase the risk of developing certain cancers.

As you begin to map out your New Year’s resolutions, experts in MUSC Hollings Cancer Center’s Cancer Control Program urge you to consider adopting healthy lifestyle changes that can lower your risk for cancer and help you become the healthiest version of yourself in 2021 and beyond.

Tips for reducing cancer risk through a healthy lifestyle

1. Lower your stress level:

Stress has long been linked to health conditions such as heart disease and high blood pressure, but new evidence published this month in Science Translational Medicine reveals that elevated stress hormone levels could cause dormant tumor cells to reawaken.

Besim Ogretmen, Ph.D., who leads Hollings’ Developmental Cancer Therapeutics Research Program, said, “Over many decades, we knew that stress levels negatively affect tumor growth and response to therapy in cancer patients without much mechanistic insight. This new study demonstrates that stress-related hormones play a key role in activating dormant cancer cells to induce tumors, which is also associated with increased cancer recurrence in patients. Overall, these studies suggest that relieving stress or trying to reduce a stressful lifestyle might be beneficial for cancer patients.”

Increased stress can also lead to unhealthy coping habits, including smoking, overeating and excessive alcohol consumption — all of which can also increase cancer risk.

2. Reduce the accumulation of AGEs:

Advanced glycation end products (AGEs) are proteins and lipids (fats) that go through a chemical alteration when they are exposed to sugars. This process occurs naturally in the body, but processed foods and foods cooked at high temperatures are extremely high in AGEs, which can lead to a dangerous overabundance. High levels of AGEs have been linked to cancer risk, and AGEs are involved in nearly every chronic disease.

“AGEs build up in a cumulative way. Fats, sugars, everything that is bad for you leads to the accumulation of AGEs,” said Hollings researcher David Turner, Ph.D., who recently led a study linking AGEs to breast cancer risk. “Just making small changes in your diet can have a big effect.”

While AGE accumulation is bad for people of all ages, there are critical windows of time, such as puberty, when eating a healthier diet is more important than usual. Research by Turner demonstrated that mice fed high-AGE diets during puberty later showed abnormal growths in mammary development that could be a precursor to cancer.

In addition to choosing healthier foods, you can lower your AGE levels by cooking foods at lower temperatures for longer, using ceramic cooking surfaces instead of metal, skipping the browning step when preparing dishes and using a food thermometer to make sure you aren’t overcooking meats.

3. Avoid smoking and alcohol use:

Quitting smoking lowers the risk of developing 12 types of cancers and can also improve survival rates for patients who quit smoking after a cancer diagnosis. Smoking decreases the effectiveness of cancer treatments and puts patients at increased risk of complications from surgery, the development of a second primary tumor and increased side effects from treatment. However, kicking the habit is often a challenge, and the stress and isolation caused by the COVID-19 pandemic isn’t helping.

“During these trying times, quitting smoking can be particularly difficult, but it is no less important. Just because we are keeping socially distant doesn’t mean that smokers are all alone in their quit efforts,” said Matthew Carpenter, Ph.D., co-leader of Hollings’ Cancer Control Research Program. “The most important thing is to get help. If you slip, don’t give up.”

A number of FDA-approved medications can double the chances of quitting, and disrupting your daily routine by substituting another activity for your favorite cues and contexts of smoking can also help.

In addition to smoking, some research has shown that any amount of alcohol use can increase the risk of certain cancer types. When alcohol and smoking are combined, the risk is higher than when using either substance on its own.

4. Maintain a healthy weight, diet and activity level:

Aside from tobacco use, the most important cancer risk factors that Americans can control are weight, diet and physical activity. Excess body weight is estimated to be responsible for 11% of cancers in women and 5% of cancers in men. Some studies have demonstrated that losing weight may actually reverse this effect and lower cancer risk, though more research is needed.

Staying active and eating a balanced diet that includes lots of fruits and vegetables, fiber and dietary calcium may greatly reduce the lifetime risk of developing and dying from cancer. Turner’s lab has also discovered preliminary evidence suggesting that exercise reduces the amount of AGEs in circulation, and in prostate cancer models, physical activity counteracted cancer progression in mice that were fed a high-AGE diet.

Any kind of aerobic exercise, including walking, can help lower risk. Evidence also suggests that limiting the amount of time spent sitting — regardless of activity level — can reduce the risk of both obesity and some types of cancers.

To reduce sitting time, try placing an exercise bike in front of the TV to stay active without missing your favorite shows, take quick walking breaks during work and park further away from the store when you run errands to get in some extra steps.

5. Stay up to date with regular preventive care:

Regular self-exams and screenings are important in the quest to catch cancers early, which can greatly improve outcomes and survival when a cancer has developed. Regular check-ins with your primary care physician are still important despite the ongoing pandemic.

“My colleagues and I at MUSC’s Hollings Cancer Center and around the world are concerned that the significant gains we have made over the past 20 years in terms of long-term cancer survival easily could be reversed due to difficulties in accessing non-COVID-related health care,” Hollings director Raymond DuBois, M.D., Ph.D., recently wrote in a commentary in the Post and Courier. “The coronavirus pandemic will end one day, but our fight against cancer will continue.”

Keeping up with doctor’s visits is also important for ensuring that you receive other evidence-based preventive care, such as the human papillomavirus (HPV) vaccine, which can prevent six types of cancers.

6. Be aware of health disparities and barriers to care:

Health disparities are defined as the inequalities that occur in the provision of health care and access to health care across different racial, ethnic and socioeconomic groups. Many factors contribute to these disparities in the U.S., including access to transportation, healthy food, recreational facilities for physical activity and specialty care — all of which can affect cancer risk and outcomes.

South Carolina has a high percentage of rural and medically underserved areas within the state, and the state’s poverty level and percentage of different ethnic and racial minority groups — such as Black Americans — is higher than the country’s average. Because of this, Hollings researchers are dedicated to understanding these disparities more fully to create solutions.

Learn more about the state’s known health disparities and the programs offered by Hollings — such as its Mobile Health Unit — to address these disparities and to get the care you need.

After battling a decade of opioid addiction, recovery coach serves as a beacon of hope

The following feature story was written for VUMC Voice. View the original story here.

Schuyler Clayton graduated high school in 2003. It was also the year he buried five friends, all of whom died as a result of substance use.

“Growing up in Appalachia, there was drug use everywhere,” said Clayton, a native of Johnson City, Tennessee. “From the kids who didn’t go to school to the athletes to everyone in between, no one really batted an eye at it. It was predominant in most of my friends’ families.”

Clayton, now an addiction recovery coach at Vanderbilt University Medical Center, wasn’t immune. He began experimenting with drugs at 18, and watching the consequences play out for his friends only fueled what quickly became a full-blown addiction to opioids.

“Their deaths didn’t stop my use. They only propelled it. I had an excuse to use the drugs because of the way I felt,” said Clayton.

He was 19 the first time he sought help from a six-week program at a local Suboxone (buprenorphine-naloxone) clinic. When the program ended, he was offered no plan for follow-up care, and he relapsed shortly after.

Over the next decade, he went through five more treatment programs, most of which were residential. Each time he was discharged, he was sent back home to Johnson City, distanced from the recovery community he’d been building and with few referrals for subsequent care. His longest period of sobriety was 10 months.

While his 20s are tough to recall, Clayton made a conscious decision at 26 to try quitting for good. He threw all his drugs away, including medications he was supposed to be taking, and within two days, the detox caused him to have a transient ischemic attack, or a brief lack of blood flow to the brain. He was hospitalized and entered his fifth attempt at treatment shortly after.

“That was the first time I took treatment seriously, because I thought, ‘Wow, I’m really going to die,’” said Clayton. “They tell you that all the time. I tell my patients, ‘You’re flirting with death,’ but it’s hard to internalize that. I think often people who suffer from addiction think, ‘I’m going to be different,’ until something happens.”

Clayton spent the next two years stabilized on Suboxone. For the first time, he could pay off a house, hold a steady job and pay his bills, but the emotional challenges of grappling with addiction only worsened, leading to depression and isolation.

“I wasn’t going to counseling or sobriety meetings. When you’re on Suboxone, it’s hard to feel like you’ll be accepted at meetings,” said Clayton, explaining that many programs are abstinence-based and biased against medications for addiction treatment.

Clayton talked his mom into attending a support program designed for family members. She stopped at his house after one of the meetings and asked about his Suboxone use, withdrawal symptoms, whether he was attending meetings and what he needed. What she didn’t know was that Clayton was actively planning suicide — a plan halted by her support.

His parents found an alternative recovery center for addiction located in Dickson, Tennessee, and Clayton embarked on his sixth treatment program — a program he credits with saving his life.

“The thing that was different about this program was that there was a plan in place for what happens after you leave. Thirty days is a small blip of time to change behavior. It’s not enough time to develop a habit,” said Clayton.

The program offered extended care after residential treatment, and once patients finished their 30 days, they were invited to stay in the community through a volunteer role, leading groups and helping other patients. Clayton spent six months volunteering before being offered a paid position, which he held for a year and a half.

“The program is community-based. We didn’t read medical charts to see what was going on. We just talked. That’s where I found my passion,” said Clayton. “On my worst days internally, I was still able to show up for patients. I realized it was something I needed to do.”

“Our patients live with a disease they don’t get help for out of fear of blame. That’s why it’s important for me to say, ‘I’m living with the same thing, and I’m not ashamed.’”

Clayton left his job at the program to start a career in addiction counseling at a recovery center in Knoxville. There, he was trained on motivational interviewing and communication techniques, learned about the stages of disease and underwent training in suicide and overdose prevention and CPR.

He stopped thinking about drugs and has been sober the full three years since.

When he saw an open job opportunity at Vanderbilt to join a new addiction “bridge clinic” for patients who are caught in the hospital system without a safe or timely discharge option, he thought the approach sounded too good to be true.

He interviewed with David Marcovitz, MD, medical director of the Bridge Clinic, to become VUMC’s first-ever recovery coach.

“Recovery coaches can play a vital link between health care systems, siloed addiction treatment agencies and community recovery supports. There is also emerging evidence they can improve addiction outcomes,” said Marcovitz, who noted he had hoped to fill the role with someone who had both training and personal experience with substance addiction.

“Lived experience helps us bridge that divide between professional treatment and the recovery community and between patients and providers. It also allows the coaches to empathize and counsel patients in a truly unique way that can be effective at times when medical professionals may not be.”

On Clayton’s first day at VUMC, Marcovitz took him straight into the hospital to meet with patients. By revealing his own recovery story, Clayton made instant connections.

“I immediately felt comfortable because I was seeing what I’d been seeing for a long time in myself and in my friends. I think patients are comforted when they see that I’m not affected by what’s going on. I talk to them on a human level, and I try to motivate them for change while also meeting them where they’re at,” said Clayton.

“I don’t go in there carrying a self-help book and saying, ‘Read this, it’s time to get sober.’ Instead, I say, ‘What are you going to do that’s going to keep you alive, reduce your harm and increase your quality of life, and how can I help get you there?’”

Part of the Bridge Clinic’s mission is to make addiction care synonymous with medical care, eliminating the shame associated with seeking help.

“Our patients live with a disease they don’t get help for out of fear of blame,” said Clayton. “That’s why it’s important for me to say, ‘I’m living with the same thing, and I’m not ashamed.’”

“Schuyler brings a passion and dedication to his work, no question, but also an understanding of our complex treatment system and the role of medication for addiction treatment that is pretty unique in the recovery community,” said Marcovitz.

When he’s not helping patients plan for discharge, he’s making sure referrals go through so no patient facing addiction leaves the hospital without follow-up care.

While his work days are dedicated to helping others, his priority when he clocks out is taking care of himself.

“It’s very important to counterbalance my own recovery with my work life,” said Clayton. “I call my sponsor on my drive home. At night, I attend meetings and sponsor other men.”

When it comes to getting sober, Clayton stresses that recovery is something no person should face alone.

“I had every reason to quit a thousand times,” said Clayton. “It wasn’t until I developed an internal drive and someone else showed me how that I was able to do it. They accepted me where I was and inspired me to be who I would eventually become.”

Four areas with a growing cyber risk of digital extortion

The following post was ghostwritten on behalf of a cybersecurity solutions firm. The topic was pitched and accepted for publishing by Cyber Defense Magazine.

In a world where it’s becoming the norm to use digital assets as a medium of exchange and to see systems updating information as soon as it’s received, it’s no secret that our digital footprints are growing exponentially. This growth in our online presence and our reliance on online tools increases the cyber risk that your business can be taken out entirely by a digital extortion attack.

Many attackers use ransomware as their weapon of choice, denying a business access to its data and demanding a sum of money for its return. And, as the internet expands, attackers are finding more ways to interrupt critical processes in hopes that it will force a business into paying them off.

So, what new technologies are attackers targeting, and what can you do to keep your business up and running? Here are some things to keep an eye on:

1. Phones: Now that you can share money and files away from your desktop, computers aren’t the only devices you need to worry about protecting. Once a hacker taps into your mobile phone, he can listen to your calls, read your text messages and access your address book and apps. He can also guide you to download malware that leads to a ransomware attack.

  • What can you do? Always be wary of what company information your employees can access from their personal devices. If they store sensitive data or files on their phones and later connect them to an unsecure network (i.e. a public WiFi network), bad actors can access that information rather easily, steal the data and demand ransom. Any personally identifiable information should only be made available through your company’s secure network. Make sure employees understand and are trained on these policies.

2. Social media: If an attacker gains access to your company’s social media account or creates a fake account under a name similar to yours, he can do instant and irreversible damage to your organization’s reputation. Attackers can share fake information on behalf of your business, gain the trust of your clients and followers and post sensitive information for the world to see, demanding a hefty fee to give you access to the account(s). Once this information has been shared, it’s difficult to remove from the public eye.

  • What can you do? Businesses should treat their social media accounts as if they’re bank accounts. Set up two-factor authentication, create strong passwords and limit account access to only a few employees. Monitor social platforms for any fake accounts that may have been created in your company’s name, as these can be just as damaging to your reputation as having your official account overtaken.

3. Real-time services: Any business that offers real-time services (such as banking
institutions, health care providers, etc.) should be especially alert for extortion attacks. Attackers know that interrupting key components of what makes your business function will put more pressure on you to resolve the issue quickly. And sometimes, resolving the issue quickly might mean paying the attacker what he’s asking for in order to avoid a longer downtime.

  • What can you do? Make sure you have adequate backups of your data and a recovery plan in place. Establish guidelines for how long your business can afford to be down and how long it will take you to restore data afterwards. Set up processes for determining where attacks may be coming from (especially if your organization employs hundreds to thousands of people), and make sure your employees know how to report any suspicious activity.

4. Cryptocurrency: With any digital asset that can equate to cold hard cash comes the threat of extortion or theft, and cryptocurrency is not immune. If you choose to buy bitcoins, be aware that attacks have already begun, and they will only become stronger and more frequent.

  • What can you do? Stay on top of the latest industry news and laws, and use backup and encryption methods to your advantage. Don’t save the passwords to your digital wallet on any personal devices or online password banks. And, when you’re not using it, make sure you store your digital currency offline.

While new technologies and digital services can pose a significant threat to your brand and critical processes, ensuring you have the proper planning and detection methods set up can save you a lot of headaches – and money – as extortion methods expand.

A psychiatrist’s journey with bipolar disorder

The following feature story was written for Vanderbilt Medicine, a semiannual magazine mailed to alumni of the Vanderbilt University School of Medicine. View the original version here.

Reid Finlayson, MD, MMHC, was nine months into his first year of psychiatric residency training when he awoke on the seventh floor of a psychiatric hospital in downtown Toronto, Ontario.

It was Easter morning in 1974, and hazy memories of being “wrestled to the floor by a sea of faces dressed in white” injecting him with sedatives flooded his mind.

Finlayson, who was 29 at the time, had recently relocated his family to Hamilton, Ontario, to study psychiatry at McMaster University after practicing for three years as a family physician in Owen Sound. His family was unhappy with the move, and the draining work required by his training program led to a lingering feeling that things weren’t going well. He had trouble sleeping, a decreased appetite and an overall sense of hopelessness.

The week before Easter in 1974, he decided to see a psychoanalyst, who prescribed him an antidepressant.

“Although I felt despondent, it was not easy to accept that I might be clinically depressed. I thought of my symptoms as the result of events outside myself. Even years later it has been difficult to accept that the changes in mood might originate from within myself,” said Finlayson, now an associate professor of Clinical Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center. “I remember thinking (rather grandiosely for my first year of residency training) that I was already as capable as any psychoanalyst.”

Within days of beginning the antidepressant, Finlayson became dissociated, confused and restless with behavior changes that concerned his family. On the morning of Good Friday, he showed up at his program director’s office door unannounced while his director was in the middle of an interview.

“I don’t remember what was said, but he was kind, recognized my distress and arranged for me to receive an injection of a major tranquilizer and be transported by ambulance to a psychiatric hospital in Toronto. He must have reasoned it would be wiser to not admit me to one of the Hamilton-area hospitals where I might work again someday,” said Finlayson. “It was my formal induction into the shame, guilt and stigma of mental illness.”

An unwelcome initiation

Upon his arrival to the hospital, Finlayson believed he’d meet with the clinical director and be sent on his way. Instead, a certificate of involuntary committal was signed, requiring him to remain on the unit for two weeks despite his personal wishes.

Angry and impatient, Finlayson’s attempts to leave the hospital anyway resulted in sedation, and he spent the next few weeks lying in his hospital bed, trying to make sense of the situation and afraid of being labeled with a mental illness.

Much of his treatment was medication based, and the doses he was prescribed only angered him further.

“I felt I was better qualified to decide how much medication I should take,” said Finlayson. “Maybe it was denial, or the grandiosity of the illness, or maybe it was the only thing I felt I could control in the hospital, imprisoned against my will.”

When the nursing staff was distracted, he hid the pills in his hand, under his tongue or in his cheek before flushing them down the toilet.

Seeing that his family was nervous to take him home upon discharge, he began taking small quantities of his medication to calm their nerves and in hopes his symptoms might improve. Instead, he felt lethargic and more depressed. He was stressed about how the events of the previous weeks might impact his career and was uncertain about continuing his education in psychiatry.

After a few weeks of misery at home, Finlayson’s family doctor referred him to a psychiatrist, who diagnosed him with clinical depression and recommended replacing the high-dose antipsychotics he had been prescribed at the hospital with another antidepressant. Within days, he returned to a state of confusion and fear and experienced sudden bursts of high energy.

Without an appointment, he walked several miles back to his family doctor’s office, who recognized his psychotic symptoms and arranged for admittance to a nearby psychiatric hospital. He was involuntarily committed for a second time, just a few weeks after his first hospitalization.

“I became extremely frightened and endeavored to escape. After the first attempt my clothing was removed, but I eloped once more and this time made it to a nearby busy highway. I tried to hitchhike, but dressed only in an open hospital gown with no shoes, I failed to hitch a ride,” said Finlayson. “It was like something you’d see in a movie.”

When the nurses got him back onto the unit, they tried placing him in a seclusion room, where he used a bed on wheels as a battering ram to force the door back open. He was injected with sedatives and woke up a full day later naked on the linoleum floor of an empty room.

“That was a pretty low point in my life,” said Finlayson. “I never had the nerve to ask to see my records from that hospital stay.”

The next day, he received a visit from a psychiatrist and faculty member at McMaster University whom he’d met during an early rotation in his residency. The psychiatrist diagnosed Finlayson with bipolar affective disorder, also known as manic depression, which is associated with mood swings involving emotional highs and lows.

He advised Finlayson to begin taking lithium, a medication that was still being investigated at the time to treat the highs and lows of mania but is now one of the most common treatments for bipolar disorder. Within days of his first dose, his behavior became more rational, and he could think more clearly. His condition improved as he returned to life at home, where he took some time away from his training to reassess his ambitions.

“At the time, I wondered if I’d ever be able to practice again and if I’d ever go back to psychiatry. I ultimately decided I felt I had made the correct choice to train in psychiatry and that I did not wish to start over in another specialty or return to family medicine. If anything, my experience as a patient only heightened my desire to learn more about psychiatry,” said Finlayson.

Despite his hospitalizations, he was welcomed back into his residency program with understanding and acceptance. Three years later, he finished his training and was invited to join the faculty at McMaster University as a lecturer in the Department of Psychiatry.

An unexpected passion

When Finlayson graduated from medical school in 1969, he originally dreamed of becoming a surgeon. After learning he only required one year of internship to become a fully licensed family physician, he took an internship in Toronto, where he met another young internist. Together, they established a family practice in the more remote area of Owen Sound, where Finlayson also served as a coroner and jail surgeon.

“At that time, I was the youngest county coroner ever appointed,” said Finlayson, who was 27. “I found that work very challenging. I saw a lot of things I wasn’t trained to manage, especially some of the grief and concern of friends and families about the sudden, unexplained or unexpected deaths I was called to investigate.

“When a 2-year-old child drowns, what do you say to the distressed mother? I had little experience. I sometimes didn’t know what to do.”

His lack of training in the emotional side of medicine piqued his interest in returning to study and train in psychiatry, a path his father had also taken.

“I tried to figure out what I could do to make more of a difference,” said Finlayson. “What could I do to help before these terrible things happened rather than making recommendations after someone had already died? How could I learn how to intervene with patients’ families to make a difference?”

Although his training taught him the ins and outs of family therapy, Finlayson believes he learned just as much from his experiences as a psychiatric patient.

“I know what it’s like to be nervous, unsure whether you can trust somebody, frightened about your situation and career, and worried about a mistake you may or may not make. Going through it yourself makes it a lot easier to understand the person in front of you,” said Finlayson. “It would take years, including many hours in therapy and years of recovery, before I was able to more completely accept and even enjoy the harmless ‘demons’ within myself that I was so terrified to face back then.”

Finlayson was hospitalized three more times after his stays in 1974 — once briefly in 1985 after reacting to chemical fumes while fixing a wind surfing board and twice in 1994 when he tried stopping his lithium prescription amid family troubles.

To his surprise, following each time he was hospitalized, he was warmly welcomed back to work.

“By and large, the psychiatrists I’ve worked with have all been very understanding. I’ve never interacted with a patient when I’ve been incompetent to do so. I’ve always been honest about when something is wrong or when others think something may be wrong,” said Finlayson.

The most effective treatment

In 2001, he moved to Nashville after many years working in psychiatry and addiction medicine to begin his career at Vanderbilt, where he had already been involved in research projects. Currently, he sees patients in both the inpatient and outpatient settings at Vanderbilt Psychiatric Hospital (VPH), teaches and supervises trainees and medical students and serves as medical director for the Faculty and Physician Wellness Program, where he provides psychological support to Vanderbilt faculty and house staff facing their own mental health concerns.

He also evaluates physicians through the Vanderbilt Comprehensive Assessment Program, which is designed for adult professionals experiencing emotional or behavioral concerns that affect their work behavior or quality.

He continues to take lithium, seeks therapy regularly as needed, even from his colleagues at VPH, and has attended countless Alcoholics Anonymous meetings to help him manage habitual drinking, another “demon” — as he calls it — he has faced. He has now been sober 26 years.

To Finlayson, these personal experiences are nothing to be ashamed of, and he often shares them with patients who are struggling with their own mood disorders and addiction to help build trust and hope.

“I sometimes get a patient who is hospitalized and is really disgruntled about it. Sometimes they’ll say, ‘You’re a doctor — you have no idea what it’s like.’ And I’ll say, ‘Wait a minute, you don’t know anything about me,’” said Finlayson.

“It was novel to experience being a patient and to learn the rituals associated with mealtimes, medications, meetings and spending long hours interacting with other patients. I know psychiatric illness inside and out, and in some ways, that’s an advantage when I’m treating patients.”

One of the biggest takeaways Finlayson applies from his own experiences when treating patients is that just because he prescribes a medication doesn’t mean the patient will take it. He understands why some patients may be reluctant, and he often prescribes liquid medications when he feels drugs are necessary since liquids are more difficult to avoid taking than pills.

He has also learned the importance of forming a relationship with each patient and getting to know what’s important to them. He believes listening without judgment or rejection builds trust and opens his patients up to more recommended treatments.

Above all else, he has learned that acceptance of oneself and of others, despite the powerful stigma that still exists around mental illness, is the most powerful tool that exists.

“I know what it’s like to be without judgment, reason and emotional control, but I did not lose my mind, my spirit or my soul,” said Finlayson. “Experience has repeatedly taught me that the most powerful enemy is my own fear. But most importantly, I realize that love and understanding are the most powerful treatments available. Without them, nothing else really works.”

Pediatric ICU doctor taps into wisdom gained from working with dying children as he faces terminal illness

The following feature story was written for VUMC Voice, a digital publication produced by Vanderbilt University Medical Center. View the original story here.

A month before his 49th birthday, Geoffrey Fleming, MD, had a biopsy of his liver to diagnose an unidentified metastatic disease that he already knew was “something bad.”

The next day, he jetted off to Scotland for a family golf trip, deferring the results of his procedure until his return.

On Aug. 26, 2019, he got the news: he had a liver and bile duct tumor known as metastatic cholangiocarcinoma, a cancer that, when treated, offers an average lifespan of 12-18 months.

As an Intensive Care Unit (ICU) provider at Monroe Carell Jr. Children’s Hospital at Vanderbilt, the concept of terminal illness isn’t new to Fleming, who has spent most of his career leading families through end-of-life conversations. While the news was disheartening, he found himself at peace knowing his life so far has been full of love and purpose.

“I know there are things worse than death — I’ve seen them in the ICU,” said Fleming. “I am fortunate to have stood at the bed of many children who died, and they have taught me how to be brave. They taught me how to live well — how to find the joy in a bowl of ice cream — and how to die with dignity and acceptance.”

“My mantra through this has been, ‘Love deeply, live passionately and demand meaning and purpose in your life.’ That for me is the shorthand answer to ‘How do you get to a place where you’re 49 facing your mortality and are at peace with it?’”

Although he can no longer safely work in the ICU due to his immunosuppression, being on the other side of the hospital bed has taught Fleming a lot about what it means to show up for patients.

For starters, he believes the role of a physician has changed from being the sole owner of information to being a knowledgeable guide who can help put information into the context of a patient’s care. He likes the term “health care docent” but realizes some might not agree with the analogy.

“All the time, our patients bring us ideas about their care, whether it’s information they’ve found on Google or that somebody has given them. I used to live by this motto that said, ‘My MD is better than your Google search.’ But, in doing so, I missed an opportunity to partner with my patients,” said Fleming.

While such dubious web-touted “treatments” as ionized water and keto diets may not cure cancer, Fleming now realizes how terrifying it can be as a patient to feel like one may be missing something that could potentially benefit their health.

“My plea to my colleagues would be to do what my doctors did, which was sit with me while I asked these questions and walk me through what was plausible, what was not plausible, what could potentially help and what could potentially hurt,” said Fleming.

Another view Fleming has gained from being on the patient side of care is the importance of establishing a connection with each patient, no matter the severity of their illness or how busy the provider’s day may be. As an ICU physician, Fleming admits he often struggled with spending enough time connecting with patients who were less sick than others, forgetting that this may be the sickest that family has ever seen their child.

As a patient, Fleming spends most of his time in waiting rooms, anxiously looking forward to the moments he’ll have with his care teams. When those moments finally come, he wants to know he’s being seen.

“When I say ‘seen,’ I don’t want them to see a 49-year-old ‘cholangio’ in room three. I want them to see Geoffrey, who is a father, a husband, an ICU physician, a golfer, someone who loves to play bluegrass bass and who is a bit of a prankster. I want to be seen as me,” said Fleming.

“As a provider, I have so often been afraid of becoming too emotionally connected to my patients or their families, because patients die. But, I’ve realized my care team is very good at making a connection with me that doesn’t require them to open the Pandora’s box of their heart. They just remember that I’m a golfer or ask me about my daughters, and it is so meaningful to me.”

Along with establishing a personal connection, Fleming has realized the power physicians have in providing patients with opportunities that make them happy, even if they may not seem like a great idea initially. He now calls this “bravery” as a provider.

In the ICU, Fleming once treated a dying boy who was a fan of the “Iron Man” movies. When a new “Iron Man” movie came out, Fleming and his nurses arranged for the child to see the movie in a theater accompanied by his care team.

“He died two days later having seen Iron Man, and he loved it,” said Fleming.

“Sometimes as providers, all we have to do is be brave and ask ourselves, ‘What could go wrong? Is this about me, or is this about the patient?’”

Fleming’s oncologist, Jill Gilbert, MD, professor of Medicine at Vanderbilt-Ingram Cancer Center, showed bravery in allowing him to fly to Scotland the day after a liver biopsy, a trip that provided cherished time with family and a chance to fulfill a golfer’s dream.

While being on the other side of the hospital bed has allowed these lessons to crystalize, Fleming says the most important lessons he’s received have come through witnessing the dedication of his colleagues and through the privilege of treating dying children.

Since his diagnosis, Fleming and his wife, Amy, also a pediatrician and Dean of Student Affairs at Vanderbilt University School of Medicine, and their three daughters have been living as normally as possible, finding joy in the little moments such as sharing dinner, playing games and taking walks with their dogs. He feels their family has always excelled at taking life one day at a time, a habit fueled by occupations that have constantly reminded them life is fragile.

“I have done as much with my 49 years as I could ever have wanted to do. I have no regrets. Even my mistakes are so interwoven into the fabric of who I am that I wouldn’t try to alter them. I’d hate to see what bits of me I would lose because of it,” said Fleming.

“My mantra through this has been, ‘Love deeply, live passionately and demand meaning and purpose in your life.’ That for me is the shorthand answer to ‘How do you get to a place where you’re 49 facing your mortality and are at peace with it?’

“I want to be a grandfather, I want to see my children grow up, I want to see many years of life with my wife,” said Fleming. “I’m sad about the idea of dying, but I certainly do not have any fear and anxiety.”