Note to Self

Posted on Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Anthony Bourdain. Kate Spade. Robin Williams. They had what most people dream of having: massive success; fame; money; and a fabulous lifestyle. And yet, on the most profound and intimate level, they were utterly miserable. They couldn’t find a way to love themselves enough to keep living.

They are not alone. Millions of people, known only to a few folks around them, suffer the torment of suicidal thinking. We’ve known for decades that most suicide victims see some sort of health care professional shortly before they die. There is no shortage of studies, articles, committee meetings, and conferences on the subject. But somehow very little seems to change.

Two days ago I heard an “expert” on TV insist we should ask every patient about his or her personal life, marriage, relationships, family and financial problems, and work stress. I’ve been quite ill in recent years, and I’ve seen multiple physicians. No one has ever asked me about any of these matters. Perhaps, since I’m a physician, they feel too uncomfortable to ask. I suspect, however, that the larger issue is our obsession with time and money. Herd ‘em in, herd ‘em out, generate more revenue. A discussion about personal problems can become lengthy and emotionally charged. It’s difficult to get a tearful, distraught patient out of the office. In far too many cases, we’d really rather not know about it. Besides, when someone is crying, it’s tough to stay focused on your computer.

We live in an ever more detached, isolated, dissociated, overstimulated, and under-loved culture. All the “fans,” “likes,” and “followers” in the world cannot take the place of one sincere, sympathetic listener who actually cares.

Morals, Manners and Mindsets

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

By Mary O’Brien, M.D.

Our culture appears to be in free fall.  Movie moguls assault young women.  Campus doctors exploit and molest patients.  Gymnastics coaches and doctors engage in appalling sexual crimes.  The abuse of women and children has occurred for millennia. However, as individuals and as a civilization, we’re supposed to be advancing.

The human person, the human body, must be treated with dignity and respect at all times, at every stage of life.  The notion that we can do whatever we want, whenever we want is wrong.  It always has been, it always will be.

Professional stature is non-existent without self-restraint and honor.  And those in leadership positions who merely look the other way bear just as much guilt as the perpetrators.  It’s shocking to realize how much disgraceful behavior is tolerated out of ineptitude, laziness, greed, or complacency.  Virtually every sector of our society is at fault here.  Until we reach a critical mass of people willing to challenge this horrid behavior, nothing will change.

In our professional realm, there are a few things we can do to restore respectfulness:

  • Call patients or clients by their proper names: , Mrs., Mr., Dr., Reverend, Judge, etc. are all appropriate until someone invites familiarity.  Using first names with a new patient is not “friendly” as we have been led to believe.  It merely signals a sloppy level of unearned familiarity and unprofessional demeanor.  A medical or dental office is not a nail salon.
  • Male professionals should not be alone in an examination room with a female patient. The “expense,” “inefficiency,” or “inconvenience” of having a nurse or assistant present is an unacceptable excuse for this breach of protocol.
  • Manners matter. “Old school” nurses and doctors were taught to ask the patient’s permission before we touched him or her.  “May I listen to your heart?”, “May I examine your abdomen?”  No doubt some youngsters in health care would roll their eyes at this.  But we should never make assumptions about touching anyone (apart from emergencies), and yet it happens routinely today.
  • It’s good to remind ourselves, our colleagues, and our students that decorum and propriety are not old-fashioned and unnecessary. On the contrary, they are critically important, and their absence is palpable.

Morals, manners, and mindsets do not exist in a vacuum.  When someone is disrespectful or unethical in one domain, that vice will eventually metastasize.  Regardless of our age, culture, or profession, we should always try to treat others the way we’d like to be treated.  It’s not corny.  It’s not outdated.  It’s our only path forward.

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.

Chocolate: A Smart Food

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

By Dr. Laura Pawlak

There is universal agreement that chocolate is a feel good food.  Chocolate melts in your mouth, releasing its sweet, creamy, cocoa flavor, and the brain follows with a burst of “happy” chemicals.

Beyond the sensory joy of eating chocolate, there are claims that chocolate is a healthy food for the brain.  Most of us would gladly eat more chocolate if proven to benefit the brain.

Several ingredients in cocoa have been proposed to explain the possible cognitive benefits of chocolate.  Cocoa contains caffeine, a substance that enhances cognitive functioning and alertness.  Major nutrients have also been identified in the cocoa bean.  Presently, studies focus on the chemical group called flavanols.

Flavanols are micronutrients found in many fruits and vegetables, especially the fruit called the cocoa bean, the basis of chocolate.  Flavanols have antioxidant and anti-inflammatory properties — important for brain health.

Small studies, often supported by chocolate manufacturers, state that the cocoa flavanols can boost mood and cognitive performance — as well as blood flow to the brain.  Researchers are now evaluating the significance of these small studies by conducting large, clinical trials using a cocoa extract with known flavanol content, not chocolate.

A dose of 600-750 milligrams of flavanols is considered healthful for the brain.  To obtain this dose, you would have to consume 4.75 ounces of dark chocolate, a total of 750 calories, or 40 ounces of milk chocolate, which has 5,850 calories.

A day with adequate flavanols from commercial chocolate is also a day heavy in sugar, saturated fat, and calories — not a formula for a sharp brain.  Perhaps future studies examining chocolate’s healthful ingredients in the cocoa extract will provide more healthful ways to capture the goodness of the cocoa bean.

Meanwhile, manufacturers divert your focus from calories to health by presenting chocolate paired with a superfood, the avocado.  Called a health food, the Avocado Chocolate Bar is made of freeze-dried avocado pulp powder, 70 percent dark chocolate — plus added sugar — and has nearly 600 calories.

The bar is a convenient, but calorie-laden, snack.  The alternative — consuming whole, fresh plant food — is always a good choice for the brain.

My suggestion:  Eat dark chocolate in moderation if you like it, not because you think it will make you smarter.  For added flavanols, focus on the abundant amounts of this nutrient in grapes and berries.  Enjoy!


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renowned 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.

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.

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.

Memory Loss

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

By Michael Howard, Ph.D.

While some memory loss — such as misplacing the car keys or wondering where that library book is — happens to people as they age, the memory loss associated with Alzheimer’s disease (AD) and other dementing illnesses is far more dramatic, severe, and progressive.

Memory loss is one of the distinguishing symptoms of AD, and it influences other aspects of the disease as well. Memory loss affects communication because the individual begins to forget words and, over time, loses the ability to read and write. Memory loss also affects mood and behavior because patients inevitably become frustrated, angry, and depressed as continual and worsening lapses impair their ability to think and function effectively. Several medications have been shown to slow memory loss and other cognitive decline. Many professionals also believe that exercises designed to stimulate memory, including memory enhancement and reality orientation exercises, may help slow deterioration somewhat. However, these exercises are demanding because they need to be repeated several times a day, and it would be helpful if caregivers could enlist the help of friends and relatives to work with the patient at specific times of the day or week.

Short-term memory loss, that is, loss of memories of events that occurred from several seconds to several days or weeks ago, is the first type of memory to become impaired with dementia. Patients may forget that they just finished a meal, or that a favorite cousin just paid a visit. Loss of long-term memory, memory for events that occurred months or years ago and that also involves remembering how to perform basic tasks such as cooking and dressing, is affected during the middle and later stages of the illness. The effects of memory loss cut across every aspect of the lives of people with AD and other dementias, affecting their ability to communicate, work, enjoy free time and relaxation, and care for themselves. In the later stages of illness, individuals lose their ability to recognize their spouses, family members, and friends. They forget how to bathe, dress, feed themselves, and use the toilet.

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.

A Different Tradition

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

By Mary O’Brien, M.D.

Has your home returned to a relative state of post-holiday normality?  I’m almost there.  The boxes and bags and bows and ribbons have been put away until next year.  The “thank you” notes are in the mail.  And my kitchen table has been restored to an acceptable state of neatness.

Many people will start to focus on new year’s resolutions now, knowing full well the resolutions are unlikely to last.  I have a different tradition at the end of December.  It goes back quite a few years.  In a reflective state of blissful solitude, I write down my own little “year in review.”  It takes some time, thought, and effort, but it’s an exercise that can generate some profound insights.

  • What were the best or most positive events of 2017 — personally, nationally, and globally?
  • What were the worst or most tragic events of 2017 — personally, nationally, and globally? How did I cope or respond?
  • What event or situation made me feel most grateful?
  • What was the most beautiful, unusual, or remarkable sight I saw in 2017? (Personally, it would be difficult to top the perfect, unobstructed view of the total solar eclipse I had from my own backyard in August 2017.)
  • What was the biggest mistake I made in 2017? This one can be tough and sobering.
  • What was the most important lesson I learned in 2017? It’s often related to the biggest mistake I made.
  • What experience or moment touched me the most deeply?
  • What was the most noble, courageous, or generous thing I did in the past year? Coming up short on this one is not a good sign.
  • And finally, what could I do in 2018 to become a better person — physically, mentally, emotionally, and spiritually?

The little, personal “year in review” may not be as fascinating as a list of the year’s top news stories, viral videos, or celebrities who have passed.  It will, however, become profoundly revealing to you 10 or 20 years from now.

Have a happy new year.

 

Let It Go!

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

By Mary O’Brien, M.D.

Did you survive Thanksgiving without major family stress or tension? If the answer is “no,” you’re not alone. Holiday gatherings don’t always bring out the best in everyone. Some folks are already frazzled by travel nightmares. Those hosting the feast are tense and worn down by days of planning, preparation, and cooking. No one ever has quite enough room in her kitchen for all the food, much less the guests who congregate in the middle of the mess. There’s nearly always one culinary mishap and someone is sure to announce she has a life-threatening allergy to gravy.

But wait! We haven’t even begun to address deeply ingrained differences in political perspectives, religious beliefs, and good, old-fashioned feuds and grudges. Was all of this supposed to be fun? Fortunately or not, many of us will have another crack at family festivity soon as we try to celebrate Christmas or Hanukkah. I have a few time-tested thoughts that might help—at least a bit.

  • Psychologists tell us that it takes 21 days to replace a bad habit with a good one. That means we have just enough time to make a difference. Starting now, try not to criticize, condemn, or complain. It’s not easy, especially in this culture. However, it will make the next family gathering much easier to endure, if not actually enjoy.
  • Remember some basic neurophysiology. The human brain cannot hold onto diametrically opposed emotions simultaneously. We can’t feel love and hatred at the same time. We can’t feel empathy and anger in the same moment. And we can’t experience gratitude and resentment all at once. It may sound simplistic, but gratitude is often the best remedy for resentment, anger, anxiety, and sadness. Those of us who have food, water, shelter, clothes, electricity, a little money, and a few loved ones have more than hundreds of millions of people around the world. Smile and say “thank you” — a lot.
  • Forgive yourself and everyone else. I’ve watched relatives feud for decades. They make themselves and everyone else miserable. None of us is perfect. We’ve all said and done things that were misguided or thoughtless. However, refusing to forgive is like drinking poison. It makes no sense. Forgiveness represents the ultimate act of overcoming ego. Let it go. LET IT GO!

Please don’t make me sing that song from “Frozen.” I have relatives who would never forgive me.