A Little Reminder

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

By Mary O’Brien. M.D.

Are you a terrorist?  Are you a drug dealer?  Perhaps a criminal of some other variety?  The fact that you are reading this makes any of those possibilities quite unlikely.  And yet, our culture now assumes the worst of nearly everyone.  In an airport, we’re all treated like potential terrorists.  Hand the clerk in a grocery store a hundred dollar bill and she checks it to see if it’s counterfeit.  Anyone needing pseudoephedrine to breathe normally is treated like as if she may be running a crystal meth lab in her garage.  That’s ridiculous.  I don’t have a crystal meth lab in my garage.  It’s in the attic.  These days, too many people can’t recognize humor, much less reality.

Needing to fly somewhere does not make someone a terrorist.  Wanting to pay cash for groceries does not make someone a counterfeiter.  Trying to breathe more easily does not make someone a meth dealer.  Hoping for some pain relief does not make someone an addict.  As a society, we are making some very misguided judgments.  I recall that seven years ago I sought help from another internist when a long list of autoimmune diseases began spiraling out of control.  The “medical assistant” asked me what my main complaint was.  When I explained I had increasingly severe pain in my hands and feet, she quipped, “We don’t do pain management.”  I had to restrain myself.  I was there for a diagnosis, not a prescription.

Pain is the single most common symptom of most malignancies, autoimmune diseases, vascular diseases, and serious infections.  Renal disease, neurological disorders, metabolic diseases, and any inflammatory process can cause agonizing pain.  And we haven’t even touched on trauma.  Most patients who complain of pain are totally genuine and honest.  Some people exaggerate, some are manipulative.  Some, but not most.

Today, we have many veterans suffering constant pain from multiple amputations and other terrible conditions.  In many cases, they cannot obtain a month’s supply of pain meds.  They are forced to endure preposterous “policies” and “protocols” created by sanctimonious idiots.

If we really understood as much as we think we do about pain, pathophysiology, or pharmacology, we would ensure that patients have the pain medications they need to function.  Opioid addiction and overdoses are devastating problems.  But forcing patients with documented causes of severe pain to suffer needlessly is simply wrong.  Everyone who has had a cocktail, a beer, or a glass of wine does not become an alcoholic.  Everyone who needs chronic opioid treatment does not become an “addict.”

The whole point of health care is to relieve pain and suffering.  Perhaps we all need a little reminder.

homestudy

The Shock Value of Anything

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

By Mary O’Brien, M.D.

Our culture is in big trouble.  Civility is under assault.  Over the past 20 years, most of us have heard increasing use of vulgar language in public and even professional settings.  Some of us have even heard vulgar language used at funerals, especially when celebrities are involved.  It’s typically done in an effort to lighten the mood.  It doesn’t work.  It’s not appropriate, it’s not funny, it’s not hip, it’s not “cool.”  More of us need to speak up and call people on it.

Rude, crude, vulgar language merely announces to the world a limited vocabulary, emotional immaturity, and a lack of class.  The timid giggles elicited by comedians using crude language is nothing more than the nervous response of an insecure audience.  When a joke is truly funny, people laugh in a genuine, spontaneous manner because they recognize a universal truth.  Really talented people don’t need to rely on incessant efforts to shock an audience.  They actually have a gift for seeing everyday realities in novel, insightful ways. The shock value of anything wears off quickly.  Before long, the whole gig becomes tiresome.

The use of vulgar language often signals a nasty, vicious, vituperative mindset. Unfortunately, most offenders don’t even realize how badly they embarrass themselves.  The disgraceful monologue inflicted on people at the recent White House Correspondents’ Dinner was a case in point.

Cruel attacks on anyone’s appearance, wishing someone would be crushed by a falling tree, and “jokes” about abortion are not funny.  The nonstop use of the “F” word only underscored the pathetic mentality of the “comedienne.”  Some folks had the spine to walk out.  Too many sat there like overdressed lemmings.

Regardless of our age, gender, profession, economic status, political perspective, race, or creed, no one will ever think more highly of us for spewing vulgar language and nastiness.  Two thousand years ago, a very wise person said, “Out of the fullness of the heart, the mouth speaks.”

Truth is timeless.

A Class Act

Posted on Posted in Continuing Education, Elder Care, Psychology, Seminars, Uncategorized

By Mary O’Brien, M.D.

The lady was a class act.  In a sea of loud, silly, and shallow people, Barbara Bush stood like a lighthouse, radiating wisdom and grace.  She demonstrated remarkable equanimity, regardless of circumstance.  Blessed with razor sharp wit and a penchant for fun, she was nonetheless known to her family as “The Enforcer.”  Candid, caring, committed, and tough, Mrs. Bush had a massive impact on everyone around her.  She set the standards high and refused to indulge any twinge of narcissism in herself or others.  It’s a testament to her character that everyone around her succeeded.  She had the longest marriage (73 years) in American presidential history and was the mother of two governors, one of whom (George W. Bush) was also the 43rd president.

There were, however, those who bemoaned the notion that she was “only” a wife and mother.  Those folks ended up looking foolish.  Mrs. Bush had no misgivings about the value of family.  She was fiercely loyal and protective, but she did have boundaries.  When pestered by the media about her role in the political campaigns of family members, she quipped, “I’ll do anything to help.  But I won’t dye my hair, change my wardrobe, or lose weight.”

The reality was that Barbara and George H.W. Bush, in the late 1950s, lost their three-year-old daughter, Robin, to leukemia.  Barbara’s hair turned white shortly after that tragedy.  She refused to hide her age, stress, or heartache by dyeing her hair.  There was nothing coy, contrived, pretentious, or conniving about Mrs. Bush.  She possessed a refreshing candor and confidence that come from authenticity.  It was clear she had no interest in impressing or manipulating others.  As was the case with Billy Graham, she said what she meant and she meant what she said.  This surely must have perplexed the glitterati in Washington.

Historians will write about Mrs. Bush for years to come.  She was a smart, gracious, strong, and virtuous woman.  Countless children learned to read as a result of her efforts.  No doubt her opinions influenced domestic and foreign policy behind the scenes.  However, Mrs. Bush possessed an uncommon degree of humility, maturity, forgiveness, and forbearance that enabled her to rise above conflict and petty partisanship.  As she once explained, “Politics is what we do.  It’s not who we are.”  Have we ever been in greater need of her example?

 

Steady As She Goes

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

By Mary O’Brien, M.D.

Are you afraid to open your financial statements for March? Have the recent market gyrations triggered a sudden interest in Xanax? Nonstop news cycles and social media postings have spawned massive overreactions to every comment made by political or business leaders. Down drafts of 1,000 points can cause even the most seasoned investors to panic. Over the past two months I’ve had to curtail my exposure to the business networks. Watching the Dow Jones Industrial Average plunge 700 points at 2 P.M. can make me feel as if I’m about to go into ventricle fibrillation. I’d rather stay in normal sinus rhythm.

Sadly, that is not a joke. I have a vivid memory of sitting at a stoplight in Little Rock, Arkansas, on October 19, 1987. It was about 5:30 P.M., and I was headed home from my office. Over the car radio I heard, “The Dow Jones Industrials are down 517 points.” I distinctly remember thinking, “Oh, he’s reading that wrong! The DOW couldn’t possibly be down that much.” It was.

Shortly after I arrived home, my beeper went off. One of my favorite patients was in the emergency room (ER) with a massive myocardial infarction. George A. was a 76-year-old gentleman from Hope, Arkansas. He had grown up in poverty but had educated himself and built up several successful businesses. He was bright, witty, charming, dapper, and gracious. But on that day, George A. had lost over a million dollars, at least on paper. He was devastated.

I grabbed my bag and raced back to the hospital. We got George admitted to the cardiac care unit (CCU). His electrocardiogram (EKG) looked awful, and he looked worse. He was utterly convinced that one dreadful day on Wall Street had destroyed his future. Around 8 P.M., George become very ill (coded). We worked on him frantically for over an hour, but we couldn’t bring him back. There was no doubt in my mind that the thought of financial ruin had literally scared George to death. I felt numb.

Later that week, two of my colleagues committed suicide. They had also lost a fortune, at least on paper. Everyone was stunned and afraid that week. One year later, however, the market had recovered nearly all of its losses. Thirty years later I still mourn the loss of three good people. For all intents and purposes, they died from acute financial panic.

I am no financial genius. But forty years of investing have taught me a few lessons that may help someone else:

  • Don’t watch market moves minute to minute. Before long, you’ll need heavy sedation.
  • Don’t dump stocks when everyone is panicking. You’ll almost always miss out on the best part of the recovery phase.
  • Remember the wisdom of the ancient Greeks: Moderation in all things. Balance stocks, mutual funds, bonds, certificates of deposit (CD’s), cash, real estate, and precious metals based on your age, health, family needs, and risk tolerance.
  • Don’t give in to ignorance, laziness, fear, or greed. Sixty-six percent of millennials have nothing stashed away for retirement. Failure to invest is one of the greatest mistakes of all.
  • No matter what happens, avoid the temptation to overreact. You are infinitely more important than your financial statements.

Now take a deep breath and open the statements from March. Steady as she goes. You’ll be fine.

A Bit of Common Sense

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

By Mary O’Brien, M.D.

Do you take care of patients?  Are you in a position to teach students or other caregivers?  These days, everyone in healthcare is simmering in a sea of policies, protocols, rules, regulations, and algorithms.  Some of them are reasonable.  A few even make good sense.  Unfortunately, however, many of them are downright dumb.  Often, by the time someone reaches the lofty position of creating assorted rules and policies, she has lost touch with her sector of the real world.  The results are not good.

In recent years I’ve been sidelined with a growing list of autoimmune diseases. I used to joke with audiences that with red hair, green eyes, and see-through skin, I was a walking collection of recessive genes.  It’s not a joke anymore.  Being in constant pain and steadily losing functional ability is not fun.  However, in my new role as “patient,” I have learned a few things that are not taught in most training programs.

In the hope that it might help a few other folks, here’s some of what I’ve learned:

  • Sunshine is our friend.  Over the years, I’ve spent far too little time outdoors.  I was a sickly little kid and a natural-born bookworm.  From the mid-1980s on, I was afraid of “skin damage.”  Swell.  Now I have decent-looking skin but my musculoskeletal system is so badly compromised I struggle to get in or out of a chair.  Please encourage patients to get some fresh air and sunshine on a regular basis — especially if these patients suffer from any chronic illness.  Vitamin D supplements are fine, but they can’t undo the damage of decades of deficiency.
  • Small comforts matter.  The point of health care is to relieve pain and suffering.  Many of our colleagues have apparently forgotten that.  Computers can provide information.  They cannot provide comfort and consolation.  There is a true art to easing another person’s misery, and it usually involves small, simple measures.  “Hugging” a king-size pillow while lying on your side can ease pressure and strain on shoulders, elbows, and knees.  Massaging a nicely-fragranced body butter into hands, arms, legs, and feet before bed can help ease the achiness that accompanies chronic illness.  It’s not a substitute for proper medication, but these measures can provide a few moments of respite.
  • Being squeaky clean feels good.  I was obsessed with hygiene even as a little kid.  But chronic pain and illness can make taking a shower, washing your hair, and brushing your teeth feel like a triathlon.  Nearly anyone who has had the flu can relate.  The most simple measures can make a difference:
    • Change pillow cases every 12–24 hours.  I did this for patients when I was a nurse’s aide 45 years ago.  I do it for myself now.  If feels nice.
    • Step up oral and dental care after meals and before bed.  This feels nice, too.  And, there are discernible medical benefits.
    • Try a shower in the morning and a warm bath at night (as long as it’s safe).  Baby wipes, facial wipes, and dry shampoo are essential for travel and chronic illness.
  • Never wake a sleeping patient for vital signs.  I can hear nursing instructors screaming right now.  However, if a patient is sound asleep, her vital signs are probably fine.  Despite all of our impressive technology and sophisticated medications, we have found nothing more restorative than good, deep sleep.

If policies and protocols eased misery, everyone would feel fine by now.  Sometimes what we need is a bit of common sense.

The Message

Posted on Posted in Continuing Education, Seminars, Webinars

Nearly three billion people throughout the world will observe the most solemn day of the Christian calendar this Friday (March 30, 2018). Good Friday services across the globe will commemorate the Passion and Crucifixion of Christ nearly 2,000 years ago. Even the wizards of Wall Street will suspend trading at noon out of respect for the solemnity of the day. In a world obsessed with narcissism and greed, it’s comforting to know there’s still a vestige of decorum left. I suppose many people today would consider it archaic, but the practice of foregoing activities associated with fun, entertainment, or self-indulgence on Good Friday still seem appropriate to me. Maybe I’m just old-fashioned, but I think the human spirit needs a little expression of reverence and restraint now and then.

I really believe there’s a timeless message for all of us in the events commemorated on Good Friday. It’s a message that’s meaningful regardless of one’s personal theology or lack thereof. It’s a message that’s been embraced by people as diverse as Buddha, Francis of Assisi, Mahatma Gandhi, Anwar Sadat, John Paul II, and countless survivors of unspeakable atrocities. The message is contained in nine extraordinary words spoken by Jesus through his agony on the cross. After being mocked, beaten, scourged, humiliated, and tortured, He uttered nine words that seem incomprehensible to this day. “Father, forgive them; they know not what they do.”

No words could have shocked his tormentors more. Both Seneca and Cicero have described in chilling detail the usual reactions of crucifixion victims. Neither the Scribes and Pharisees, nor the Roman centurions, could have been prepared to hear words of forgiveness from their Victim. Quite the contrary, they would have expected a vastly different response. Even the Man who preached, “Love your enemies” could not be expected to speak forgiveness in response to such hideous torment.

Any thinking person, regardless of creed or culture, can’t help but ponder the ramifications of that kind of forgiveness. How would human history change if everyone practiced that virtue? There would be no fights, no feuds, no lawsuits, no wars. Hostility and revenge would cease to exist. There would be no prejudice or persecution. It’s difficult to fathom a world where forgiveness is foremost in everyone’s mind. But it would surely be close to paradise.

The message of Good Friday goes far beyond doctrine or dogma. It speaks to the exquisite potential within the human spirit to rise above the mean, vicious, and cowardly face of evil. No message could be as noble or as necessary for the world we live in today.

 

A Very Long Reception Line

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

By Mary O’Brien, M.D.

He was a bright light shining in the darkness.  Billy Graham changed the lives of hundreds of millions of people.  His message was simple and consistent:  God loves you.  He wasn’t concerned about denomination or fine points of theology even though he knew the Bible about as well as anyone.  He was a bold but humble force for good in the world.

In an age when being snide and snarky is considered “cool,” Billy Graham’s sincerity, honor, and compassion provided a beacon of hope.  Today, few things come more easily than cynicism.  I struggle with it every hour of the day.  But Billy Graham managed to rise above that temptation throughout his long life.  He never worried that someone might ridicule, criticize, or dismiss him because he never worried about himself.  Few people manage to subdue their egos the way Billy Graham did.  His lifelong focus was to share God’s love with as many people as possible.

Living a faith-filled life is very difficult.  Mother Teresa understood that. Pope John Paul II knew it.  Brave souls like these never agonize over focus groups, polls, or surveys.  Political correctness and fence-straddling, psycho-babble have no place in their lives.  They really do answer to a Higher Power.

Billy Graham gave spiritual counsel to 12 presidents regardless of their political party or religious affiliation.  He didn’t need to play games, massage egos, or create clever sound bites.  He said what he meant and he meant what he said. He had a clear understanding of right and wrong, and he wasn’t embarrassed by it.

Status had no claim on him. He lived a simple, scandal-free life.  For decades he showed as much attention and kindness to orphans in huts as he did to heads of state in palaces.

Finally, Billy Graham gave us all a noble example of how to endure the ravages of illness and old age with grace and dignity.  As we have seen with other saintly individuals, his patience, courage, and good humor endured until the very end. Protracted illness, pain, and suffering could not conquer the Spirit that worked within him.

I’ve heard it said that when you die, all the souls you’ve helped along the way are there in heaven to greet you.  In Billy Graham’s case, it must have been a very long reception line.

One Devastating Flaw

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

By Mary O’Brien, M.D.

It happened again.  Seventeen precious lives were snuffed out by a vicious young man.  Before their bodies were laid to rest, “experts” began screaming at one another on TV.  However, finger-pointing, shouting matches, and emotional rants do not solve problems.  Thoughtful, well-informed, practical strategies solve problems.

Clearly what we have been doing to prevent school shootings has been inadequate.  The reasons are myriad.

  • Gun control laws are flawed.  I’ve long been baffled by the fact that there are more restrictions on me as a physician prescribing four ounces of cough syrup containing codeine than there are on a violent teen buying an assault rifle. Most reasonable people would probably agree:  This makes no sense.
  • Counseling is a fine endeavor.  We need more of it. But caring, prudent advice will not stop slaughter.  It’s impossible to reason with someone who is irrational.
  • School security needs attention.  In Israel, schools are locked at the final morning bell and teachers with military training carry hidden weapons. We now have hundreds of thousands of well-trained veterans who could help secure schools and do data mining of social-media sites to enhance intelligence analysis.  Why are we not enlisting their help?
  • Over the past 30 years, children have been exposed to tremendous levels of violence on TV, in movies, and perhaps most intensely, in video games.  Here there are no consequences to killing, apart from racking up points. Many kids who have been left to fend for themselves never have been taught to respect another person.

Additional resources providing better security, practical law enforcement, and sensible mental health care are needed almost everywhere.  But one devastating flaw remains.  Many people realized the shooter in Florida was dangerous.  The police had been called multiple times over the years.  He had beaten his mother and reportedly tormented and killed small animals.  His social media postings threatened murder.  Other students feared him and school authorities expelled him.  The FBI failed to follow-up on two credible reports.

Why do any of us fear getting involved in difficult situations?  It’s simple. We’re scared to death we might be sued.  We’re afraid of revenge or even the possibility of being called “mean.”

Many years ago, I had to confront a serious situation in a training program. Patient safety and professional standards were on the line.  I took action I deemed necessary and was clobbered with a lawsuit along with several other faculty.  It made our lives a living hell for nearly five years.  Other physicians and administrators simply looked the other way.  They suffered no retribution.  Some of us did what we believed was right.  Some chose to remain silent.

On February 14, 2018, many people did the right thing.  Some of them died trying to save others.  None of us is off the hook here.  Fear can have fatal consequences.  Courage is the antidote.

A Bit Of A Twist

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

By Mary O’Brien, M.D.

Have you given a thought to Valentine’s Day yet?  I suspect for most people it’s a last minute scramble for dinner reservations or roses.  The Valentine cards and candy in stores have been staring us in the face since Christmas Eve.  But most of us have had a few other things on our minds, things like floods, flu, holiday bills, and taxes.  Hearts and flowers aren’t top priorities for most folks unless they work for Hallmark or Russell Stover.

This year there’s a bit of a twist.  February 14th is Valentine’s Day and Ash Wednesday.  It’s most unusual.  As soon as I noticed this anomaly on the calendar, I realized several things would happen.  Some people would turn it into a theological controversy over which observance should take precedence.  I’ve always been perplexed by the propensity of some people to promote “either-or” thinking.  Sure enough, several prominent clerics have issued stern statements about the obligation of their members to fast and forego any Valentine treats.  That’s their call.

Some people will slog through the day unaware of either observance.  They don’t worry about philosophical or theological dilemmas, and, for the most part, they’re not terribly romantic or thoughtful to begin with.  No big deal.

I have a different take on this.  As a 63-year-old woman, I’ve had my share of lovely Valentine surprises and a few bitter disappointments.  That’s life.  As a geriatrician, I know how many sick, lonely, elderly people are ignored on Valentine’s Day.  That’s sad.  As a lifelong Catholic, I understand that Ash Wednesday is all about spiritual priorities and discipline.  We’re not supposed to be self-indulgent morning, noon, and night.  That’s prudent.

Here’s the good part:  Valentine’s Day and Ash Wednesday don’t have to be at odds with each another.  There is no need for “either-or” thinking.  St. Valentine was a real man, a priest who brought great kindness and love to persecuted people in third century Rome.  He was martyred for his devotion in 270 A.D.  Ash Wednesday is a major reminder that life is short.  The only thing we’ll take with us at the end is the love and compassion we have shown to others.

We all have patients, colleagues, neighbors, and even passing strangers in our lives who will be neglected on February 14th unless we remember them.  Valentine’s Day and Ash Wednesday.  Curious.  There’s never a need to “fast” from being thoughtful.

That Time Of Year Again: Cold and Flu Season

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

By Mary O’Brien, M.D.

It’s that time of the year again.  It’s that awful season when nearly every third person you encounter looks and feels miserable.  Headache, fever, cough, congestion, myalgia, and malaise signal flu season is in full force.  Health officials are already proclaiming this (2017-18) the worst flu outbreak in over a decade.  Considering the dreadful natural disasters of 2017 and record-breaking cold temperatures across two-thirds of the nation, we shouldn’t be surprised.  Every year flu outbreaks spike shortly after the holidays, and the travel, stress, sleep deprivation, and crowds associated with the holidays.

A few time-tested, common sense measures may help protect you, your loved ones, colleagues, and patients:

  • Wash your hands. Wash your hands.  Wash your hands — thoroughly and often.  Hot, soapy water is best, but hand sanitizers and disinfectant wipes come in handy at the grocery store or in the car.
  • Avoid touching your face, especially around your eyes, nose, and mouth. These areas can serve as an entrance ramp for viruses.  Try to resist the temptation.
  • Increase your fluid intake. Bitter cold temperatures combined with heat from furnaces and fireplaces increase insensible fluid losses (fluid lost from skin and breathing).  The resulting dry mucus membranes are not only uncomfortable, but they’re more vulnerable to viral penetration.  Water is best here.
  • Get more sleep than you think you need. A single night of inadequate sleep can compromise lymphocyte numbers and function.  Give your immune system the restorative time it needs to protect you.
  • Don’t overextend yourself. Most folks are already tired from the holidays.  Give yourself some downtime before you have no choice in the matter.
  • Avoid crowds like the plague. Contagion is partly a numbers game.  No one has to go to a crowded movie theater or restaurant.  Stay home and clean out a closet.
  • Consider getting a flu shot now. So far this year (2018), the efficacy rating is not good.  But, some protection is better than none.  Remember, antibody production will take about two weeks after the shot.

And — finally — if you do get the flu, please stay home.  There is nothing noble or heroic about spreading influenza to colleagues and patients.

In the meantime, stay warm and well.  I have to go wash my hands now.