Random Acts Of Coolness

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

by Mary O’Brien, M.D.

I live in Myrtle Beach, South Carolina.  In the dead of winter, I’m grateful for that.  Right now (during mid-summer), however, it’s the dead of “awful.”  The temperature has been in the mid to high nineties for several weeks, and I suspect there may be lower humidity in a steam shower.  For that added touch, traffic is terrible.  Tourists are tripping over one another, and everyone is cranky.  I’ve thought about moving to Alaska.

Yesterday, on the way home from the grocery store, I drove by a utility crew digging a huge ditch.  For a split second, I caught the glance of a very large, burly man crawling out of a hole.  He was covered with dirt and sweat.  I thought he was about to collapse.  In a heartbeat, the “do something” physician-part of me began to debate with the shy, introverted, aging woman part of me:

“This man is on the verge of heat exhaustion.  I should stop and offer help.  But with what?   A trunk full of cereal, paper towels, and cat food?  It’s really none of my business.  This is their job.  Besides, it’s probably not safe to pull over. Blah, blah, blah…”  Perhaps you know the routine.  I can debate myself for hours.

A mile down the road, I turned into my driveway — still conflicted.  Then it dawned on me. “I am an idiot.  This is not a difficult decision.”  I dumped my groceries in the kitchen and grabbed what I could from the fridge:  bottles of water; Coke; lemonade; and Hawaiian Punch.  I know, I know — I have the taste buds of a ten-year old.  Then, I raided my stash of ice cream bars from the freezer and headed back out.  As I pulled up to the work site and got out, the crew looked baffled.  I suspect the crew thought some fussy woman was about to start complaining about the mess or the congestion.  It happens.

I explained I had driven by ten minutes earlier and was worried about them.  When I pulled out the cold drinks and ice cream bars, their jaws dropped.  They still looked as if they were about to fall over, but this time it was from shock.  By the way, I’m not the only one with the taste buds of a ten-year old.

If you’re ever in a similar situation and you feel conflicted, choose the “random act of coolness.”  You’ll feel better about everything all day long.

Little Charlie

Posted on Posted in Brain Science, Continuing Education, Pain, Psychology

By Mary O’Brien, M.D.

Do you know what “Mitochondrial Deficiency Syndrome” is?  Most people don’t.  Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard.  Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria.  Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate).  In essence, ATP represents energy at the cellular level.  Without ATP, cells, especially brain and muscle cells, cannot function.  The most sensitive and vulnerable cells in the body are those of the cerebral cortex.  Little Charlie cannot see or hear or move or swallow or vocalize or think.  No one can know with absolute certainty, but he probably cannot “feel” anything at this point.  The word tragic is utterly inadequate.

The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing.  Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become.  Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation.  Some timeless principles are useful:

  • Embrace humility.  Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
  • Exercise the intellectual discipline to learn the facts involved.  In medicine, every patient is unique.  Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
  • Resist the temptation to become emotional.  Unbridled emotions cause far more problems than they solve.  Try to be the voice of reason.
  • Try not to confuse or conflate the issues.  People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology.  The case of Charles Gard is about medical ethics.
  • Focus on principles, not personalities.  There is a colossal difference between saving life and prolonging death.  Remember, there is never a moral imperative to render futile care.

Primum non nocere.  (First, do no harm.)  There’s a reason that Solomon prayed for wisdom.

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Minimizing Summertime Maladies

Posted on Posted in Continuing Education, Homestudy, Psychology, Webinars

By Mary O’Brien, M.D.

Triple-digit temperatures.  Devastating storms.  Disease-carrying insects.  Rip currents.  Shark attacks.  Jelly fish stings.  Fireworks accidents.  Food poisoning.

This list of problems only scratches the surface of serious summertime challenges.  But an ounce of prevention really is worth a pound of cure.  With that in mind, let’s consider some tips for minimizing summertime maladies:

  • Never leave an infant, child, adult, or pet in an unattended car.  Temperatures can soar past 120 F within minutes, even with the windows cracked.  Within 20 minutes, temperatures can exceed 140 F.  Every summer, mere carelessness leads to terrible tragedies. Please educate the people around you.
  • If a storm is close enough for you to hear thunder, it is close enough for you to be struck by lightning. Get inside a car or building.  Do not seek shelter under a tree that could turn you into a veritable lightning rod.
  • Most hurricane-related deaths occur as a result of drowning. People who are out and about can face dangerous flash floods.  Never attempt to drive through standing water.  It takes only six inches of water to move a vehicle.  Unless you are a first responder, please stay put in the immediate aftermath of a severe storm.
  • These days, mosquitoes are more than a nuisance. The West Nile virus is already active in many states and the Zika virus remains a threat to pregnant women in particular.  Eliminating standing water such as bird baths, planters, or backed up gutters where mosquitoes can breed can help.  Avoiding outside activity at dawn and dusk when mosquitoes are out in full force would also help.  Spraying protocols and insect zappers or traps may be worthwhile.
  • Be prudent at the beach. Warnings about rip currents, sharks, jellyfish, contaminants, or other dangers are not issued to ruin everyone’s fun.  Every summer, needless tragedies occur because people do foolish things.  Be the voice of reason for younger people around you.
  • Drink alcohol sparingly, if at all.  The vast majority of fatal boating accidents involve alcohol.  Even on shore, alcohol and high temperatures can be a disastrous combination.
  • Let professionals handle the fireworks. No one ever imagines they could be horribly burned or blinded by an accident with a firecracker.  Sadly, that is not rare.
  • Keep any meats or side dishes made with mayonnaise at proper temperatures — hot or cold. Food poisoning can have consequences far beyond an upset stomach.  When in doubt, throw it out.

Summertime is supposed to be fun.  With a little prudence and common sense, it can be precisely that.

The Healing Power of Touch

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Seasoned politicians understand it.  Talented athletes get it.  Even newborn babies are “all in.”  Unfortunately, too many professionals in health care seem to need a reminder.  We’re slightly distracted by gadgets these days.  Actually, touching patients has become, well, “yucky.”

Savvy politicians realized long ago that patting another person’s shoulder as they shook hands elicited more support and cooperation.  Players in the National Basketball Association who engage in more high-fives, fist bumps, and “guy hugs,” are apt to play better as individuals and as a united team.  (Believe it or not, psychologists have actually studied this.)

The landmark research on positive touch dates back many decades, revealing that newborns deprived of caring, gentle, living touch resulted in failure to thrive despite adequate nutrition.

Research into the neurophysiology of touch demonstrates remarkable conditions between pleasant, soothing sensations and social connectedness.  In a nutshell, “A-beta” nerve fibers conduct impulses related to touch.  These touches are triggered by– displacement or movement of long hairs on the skin — by vibration, movement, indentation, and stretch.  “A-beta” fibers enable us to detect a wobbly table, a greasy dish slipping out of our hands, the weight of a puppy curled up against us, or the wind blowing through our hair.

Another type of fiber, “A-delta,” carries information about the movement of short hairs on our face or body.  These sensations are decidedly unpleasant like walking into a spider web or feeling a bug crawling up our arms or legs.  Assorted other fibers carry pain impulses at a very rapid rate so that we can react and hopefully survive.

However, the newest nerve fibers to be discovered are part of the emotional or affective touch system.  They are called CT or “C-tactile” afferents.  These fibers transmit impulses associated with gentle, pleasant, nurturing sensations — an affectionate pat, a warm hug, or a loving caress.  Compared to pain fibers, “C-tactile” fibers are slower to respond, perhaps encouraging the pleasant interaction to linger a little longer.

Gentle touch fosters human interactions, togetherness, and nurturing for survival.  It’s fascinating that touch is the first to develop in utero and the most highly developed one at birth.

Clinical research is underway to study the effects of gentle, pleasant touch on conditions including autism, neuropathic pain, depression, and spinal-cord damage.  Why wait?  Let’s put the gadgets aside for a minute and touch the patient.  You’ll both feel better.

References
— Denworth, L. The Social Power of Touch.  Scientific American Mind.  July-August 2015, pp. 30-39.
— Voos, A.C. Periphery, K.A., and Kaiser, M.D., Autistic Traits Are Associated with Diminished Neural Response to Affective Touch.  Social Cognitive and Affective Neuroscience, Vol. 8, No. 4, pp. 378-386, April 2013.

The Sounds of Silence

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

By Mary O’Brien, M.D.

Paul Simon and Art Garfunkel had a huge hit with “The Sounds of Silence” about 50 years ago.  It resonated with millions of people.  Back in the late 60’s and early 70’s, excessive noise was considered a form of pollution, and that was long before anyone knew what a cell phone is.

Today, the scourge of excessive noise defies description.  Unfortunately, it has metastasized, with some devastating consequences, into every nook and cranny of health care.

People in medical and dental practices, hospitals, pharmacies, nursing homes, and every other patient-care area are bombarded by incessant noise.  Blaring TV’s, radios, “ patient-education” videos, cell-phone conversations, and shrill chatters continuously assault people who are sick and in pain.  Some are them are even patients.

What exactly are the consequences of noise pollution in healthcare?  For starters, staff members become increasingly edgy, irritable, and distracted.  Burnout is rarely far behind.  Patients and family members are often restless and annoyed.  Patients in hospitals and nursing homes cannot rest or sleep.  The resulting physiologic cascade can be staggering:  1) blood pressure and pulse increase; 2) glucose levels rise; 3) adrenaline, noradrenalin, insulin, and cortisol levels rise; 4) lymphocyte counts fall;  5) pain thresholds drop; and 6) tempers flare.  Rarely, however, does anyone make the connection.  What should we do?  Let’s take better care of ourselves in order to take better care of our patients.  Turn the sound down, or, better yet, turn it off (at least for a little while).  The sounds of silence are long overdue.

Arthritis and Diet

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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And The Winner Is…….The Grape!

Posted on Posted in Continuing Education, Nutrition, Psychology, Seminars, Webinars

Nature introduced our ancestors to the first sampling of wine about 10 million years ago. As fruit ripened and fell to the earth, a natural process of decomposition occurred.

Microbes in the soil turned fruit sugar into a simpler component, ethyl alcohol.  Some curious, hungry ancestor, eating the decaying fruit, probably rejected the taste, but loved the altered state of mind.  A sophisticated version of nature’s process, called fermentation, was perfected, producing wines that delight the palate as well as the mind.

My  grandmother lived in rural Manitoba, Canada, and made her own wine from wild berries picked in late summer.  Her doctor recommended a glass of wine each night for good sleep and longevity.  In her generation, that glass was small, holding a mere four ounces.  Although today’s wine goblet may be enormous in size, the recommended intake of wine remains 4-6 ounces per day.  At high doses, the alcoholic content of wine may be both addictive and toxic to the brain.  An alternative choice is nonalcoholic wine.

Fermentation of the grape produces any array of chemical changes.  In addition to the conversion of sugar to alcohol, compounds in the grape’s skin and pulp are released, creating more than color, aroma, and a distinctive taste.  Vitamins, minerals, and an array of other nutrients are released into the liquid brew.  One of the heart-healthy plant chemicals concentrated in wine is the antioxidant resveratrol.  How does the content of resveratrol in wine compare with that in grapes or grape juice?

Resveratrol contributes color to grapes.  Red, purple, and black grapes are better sources of the chemical than white or green grapes.  Secondly, there is more resveratrol in the skin of the grape than in the pulp.  Fermentation releases the resveratrol from the grape’s skin into the liquid.  Thus, for the same weight or volume, red wine generally has more resveratrol than dark grapes or its juice.  Keep in mind that the fresh grape is an excellent choice, perhaps better than grape juice or wine.  For variety, peanuts, pistachios, cocoa, blueberries, and cranberries are good sources of resveratrol.

If you want more resveratrol in your diet, get it from food or wine, not from pills. Whole food or a glass of your favorite wine contains nutrients that work with this super antioxidant (resveratrol) for more healthful years.


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

Avoiding Holiday Weight Gain

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars

pumpkin-pie-520655_640Turkey, stuffing, mashed potatoes, gravy, sweet potato casserole, cranberry sauce, more mashed potatoes, pumpkin pie, pecan pie, cherry pie, triple chocolate cheesecake, cookies, fudge, fruitcake. Okay, pass on the fruitcake. Is it any wonder why the vast majority of exercise equipment is sold in the month of January? This year, with a little foresight and planning, things could be different.

Prevention has always been preferable to cure. A few weeks of “preventive dieting” is not a bad way to avoid the shock and horror of stepping on the scale in January. It need not be as stringent as clear liquids and lettuce from Thanksgiving to New Year’s. That would be cruel and unusual punishment. However, a few, simple, common sense measures really can make a significant difference:

  • Have a healthy breakfast with some protein and whole grains. People who routinely eat breakfast (not a crème-filled doughnut) consume an average of two hundred calories less per day than people who skip breakfast.
  • Try not to drink calories. Avoid sugary beverages such as sodas, sweetened tea, lemonade, juice drinks. Diet sodas may be tempting, but they can actually cause an increase in appetite.
  • Cut back on alcohol for several weeks. Save the wine or cocktails for the really special meals. Alcohol consumption generally increases significantly from Thanksgiving through New Year’s. Unfortunately, alcohol is loaded with empty calories and can slow metabolic rate. It also disrupts normal sleep architecture.
  • Preserve and protect sleep. Multiple studies now confirm that sleep deprivation in both children and adults is associated with weight gain. There is no mystery. Even one night of inadequate sleep can adversely affect numerous hormones, including cortisol, thyroid, growth hormone, leptin, and ghrelin. Metabolic rate can drop and appetite increases. The result is weight gain. Ease up on the late nights and parties.
  • Aim for 30 minutes of exercise every day. There’s no need to wait for January 2. The benefits of exercise are legion. Apart from the improvement in conditioning, strength, and flexibility, exercise is a terrific way to cope with holiday stress, improve sleep quality, and possibly escape annoying relatives for a while.
  • Have a light, high-protein snack before heading off to a party. Working all day, skipping dinner, and arriving at a party in a state of semi-starvation is a recipe for overindulgence. Some yogurt, a little cottage cheese, or a small bowl of cereal before leaving the house can boost self-control in the face of tempting treats.
  • Downsize plates, bowls, glasses, and mugs. Most people will eat whatever food is presented on a plate, whether it’s 10 inches or 6 inches. Use small luncheon plates or salad plates at home for every meal. This is a great strategy for year-round weight control.
  • Split dessert with a friend even at the “big event” meals. TUMS will not be required as the after-dinner mint.

Avoiding holiday weight gain is not the impossible dream. It’s entirely possible with a little planning and discipline. Besides, no one will really miss all that fruitcake.

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Managing Holiday Stress

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology

They’re coming: Thanksgiving; Hanukkah; Christmas; and New Year. Weeks of potential, nonstop stress are right around the corner. And, all of that is followed by seemingly endless bills, three or four months of miserable weather, and tax season. What could be better? Medically speaking, all of this can lead to a perfect storm of illness. Too much stress and too little sleep can set the stage for everything from colds, flu, and pneumonia, to hypertension, heart disease, and diabetes out of control. The discussion about holiday stress aggravating anxiety and depression could fill a book.

The reality is difficult to deny. During this wonderful but weird time, millions of people will go places they really don’t want to go. They will do things they really don’t want to do. And, in many cases, they will visit people they don’t even like. This is not necessary. Too many activities, too much chaos, noise, and stress, not to mention too many calories and too little sleep, combine to create a physiologic disaster. Before the madness begins, a few principles of prevention may help:

  • Minimize caffeine and alcohol. Alcohol is loaded with empty calories and will disrupt normal sleep architecture.
  • Avoid holiday exhaustion. It’s okay to decline invitations. Try not to go out two nights in a row and schedule some quiet time instead.
  • Make time for exercise. It will help dissipate stress, boost energy, and facilitate better sleep.
  • Avoid unrealistic expectations. Don’t try to recreate a Norman Rockwell scene. It puts too much pressure on everyone.
  •  Aim for a few lovely memories—not a credit card extravaganza. Overspending is a major contributor to holiday stress.
  • Be prepared to overlook a lot. Everyone has annoying relatives. We can’t control what they say or do, but we can control our response to it. Don’t let a thoughtless remark ruin the day for everyone.

In short, managing holiday stress involves a healthy dose of common sense. Don’t overeat, overindulge, overreact, or overspend. Do try to have a healthy routine with a little less food, a lot less chaos, and for more rest. That’s a good plan for any time of the year.webinarsSeminars-CTA

 

A Brief History of Pain

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

first-aid-908591_640By Dr. Mary O’Brien, MD

Early humans explained the mystery of pain by associating it with evil, magic, and demons. Relief was the responsibility of sorcerers, shamans, priests, and priestesses, who treated their clients with herbs and rituals.

On stone tablets, ancient civilizations recorded accounts of pain and the treatments used, including pressure, heat, water, and sun. The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system were involved in the perception of pain. During the Middle Ages and into the Renaissance, evidence began to accumulate supporting these theories. Leonardo da Vinci and his contemporaries came to see the brain as the central organ responsible for sensation, with the spinal cord transmitting sensations to the brain.

In the 19th century, pain came to dwell under a new domain—science—which paved the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. In the late 1800s, research led to the development of aspirin, to this day the most commonly-used pain reliever. Before long, anesthesia—both general and regional—was refined and applied during surgery.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are two basic categories of pain, acute and chronic, and they differ greatly.

Acute pain usually results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly—for example, after trauma or surgery—and may be accompanied by anxiety or emotional distress. The cause of acute pain can generally be diagnosed and treated, and the pain is self-limiting—confined to a given period of time and severity. In some instances, it can become chronic.

Chronic pain is widely believed to represent a disease in and of itself. It persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain often persists longer than three months, or longer than expected for normal healing. It can be made much worse by environmental and psychological factors. It can—and often does—cause severe problems for patients, as pain signals keep firing in the nervous system for weeks, months, or years. There may have been an initial mishap such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis, cancer, or infection. However, some people suffer chronic pain in the absence of any past injury or evidence of illness.

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