Mindfulness and Social Connections Soothe Anxiety and Boost Immunity

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

By Andrea D’Asaro, MBSR

It is normal to be scared and even paralyzed in the midst of so much uncertainty around the Coronavirus (COVID-19). That’s where simple mindfulness practices can help us stay grounded and connected despite recommendations for social distancing and work at home for many Americans. Deep breathing can slow anxiety, depression and keep our nervous system stable. Reaching out to others can boost our sense of connection, increase oxytocin (the love hormone), and maintain our immunity, which can fall when stress rises.

1. Come back to the moment with five mindful breaths

It’s easy to immerse oneself in the constant stream of on-line and often conflicting information. This can also increase our anxiety. With stress, the rational part of our brain can spin out of control into survival mode or fight, flight and freeze.

Whenever you notice yourself ruminating, worrying or feeling overwhelmed, try 5 mindful breaths:

Sit in a comfortable seat with your feet on the ground (lying down or standing are also options) breathe slowly in through the nose and out through the mouth to slow the nervous system, count five breaths with in and out, counting as one. Pause at the end and check your body and mind to see if anything is different. Continue to 10 or 20 breaths, as you wish. You may want to count your five breaths on your fingers, tracing each digit while taking one breath as an additional grounding with the body.

2. Reach out to friends and boost oxytocin

Social distancing is not emotional distancing! We can increase our happiness when we make real-time connections with others and bring ourselves a spurt of oxytocin, “the bonding hormone.” Try calling distant relatives, friends and others who may feel isolated at this time, using an old-school technology–the phone! When we take the step to converse with relatives or friends, we are boosting our own mood with activation of serotonin, according to research from Stanford University School of Medicine. Such social support is associated with a decreased risk of infection and reduced stress hormones, according to research from Carnegie Mellon University.

Many senior living communities are limiting visitors and keeping elders apart from each other to avoid spread of the virus. Older people, who may not use email or social media, are already at greater risk for depression or anxiety. We know that loneliness is deadly too. Real- time phone calls allow us to hear emotion in another voice and exchange concerns and pleasantries; it’s much more engaging than texting, according to research from the University of Wisconsin.

In this time of the elbow bump, we are advised to avoid hugging. No worries, the self-hug can also enhance the oxytocin, also called the “bonding hormone”.

Try the self-hug: Open your arms wide as you take a breath in, then cross them over your chest and you breathe out. Gently grasp your upper arm with the opposite hands and give yourself some kind squeezes. If it’s comfortable for you, close your eyes and bring to mind your personal “circle of caring.” Imagine the faces of those people or pets who care deeply for you (living or decreased) around you, smiling tenderly. Or envision your favorite happy place like a fireplace or a cozy bedroom. Remember to hold your hug for 20 seconds or more for the best benefits.

3. Strengthen self-care with mindfulness

Mindfulness is all about paying attention on purpose. This means observing how you feel, what your body and mind is craving and how you may best care for yourself. Instead of reaching for social media, a new video, or a less nutritious treat, consider the best way to nurture yourself–what you might recommend to a good friend.

During these anxiety-provoking times, remember the tried-and-true stress reduction strategies. Do you best to get adequate sleep, exercise regularly, spend time in nature and employ relaxation techniques on a daily basis.

Meeting a friend for a brisk walk in nature while bringing your attention back to the moment can bring multiple benefits. You might also consider slow mindful walking where you bring attention to each foot as it touches the ground. It’s helpful to say, “heel, ball, toe” as you notice the movement of the foot against the ground. Enjoy your slow walking and remember, there’s wrong way to bring yourself mindfulness.

Prioritizing these behaviors during the coronavirus crisis can go a long way toward bolstering your immune system and increasing your psychological well-being. Caring yourself in these ways may be a new habit to build over time, so start with one practice at a time and add on as you go, with kindness. Giving yourself kindness allows you to extend it to others who are struggling at this time.

Coronavirus (COVID-19): Reason, Prudence and Common Sense

Posted Posted in Continuing Education, Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Mary O’Brien, M.D.

A pattern is emerging.  Clinical and laboratory experience in several countries reveals that there are two strains of coronavirus (COVID-19).  The virus is comprised of an unstable single strand of RNA that is mutating.  This is known as antigenic drift and it is expected.  Researchers have identified an “L” strain and an “S” strain.  At present, the “L” strain appears to be associated with more severe symptoms and a higher mortality rate.  More widespread and accessible testing (which is now underway) will help us discern which strain is prevalent in various regions.

The vast majority of deaths have occurred in elderly people with significant underlying illness.  The cluster of patients in a nursing home in Kirkland, Washington, underscores the fragility of sick, elderly patients in enclosed settings.  Outbreaks on cruise ships reflect a similar pattern of transmission.  A large percentage of cruise passengers are over 50.  People don’t like to think of 50 as older, but physiologically, it is.

Clinically, patients with more serious illness have a high fever (over 101°F), a deeper-sounding cough (not a tickle in the throat), and shortness of breath.  The mortality rate in countries with good health care is around one percent.  China and Iran are impossible to assess, but mortality rates there appear to be around 3.4 percent.  Older men in China have very high rates of smoking, which is a crucial factor in both morbidity and mortality.

For now, several additional practices make sense:

  • Minimize or restrict visitors to patients in hospitals and nursing homes. Sick, elderly people need to be protected.
  • Frequent, thorough hand-washing with soap and hot water for 20‒30 seconds is best; hand sanitizers are second best. Keep your hands moisturized to avoid cracked skin.
  • Don’t eat with your fingers; don’t lick your fingers.
  • Keep your hands away from your face, eyes, nose, and mouth.
  • Sanitize your phone everyday. It’s the filthiest thing you touch.
  • Facial hair on men is a veritable Petri dish for microorganisms — especially among the nose, mouth, and chin. Now would be a good time to shave.
  • Change your pillow cases everyday.
  • Don’t waste your face masks. Surgical masks protect other people from your coughs and sneezes.  They don’t protect you from others.  Besides, many viruses penetrate our immune defenses through our eyes.
  • Toss your toothbrush at least every month, and whenever you are feeling ill.
  • Increase oral care with antiseptic mouthwash several times a day.
  • Stay well-hydrated to optimize the integrity of mucous membranes.
  • Let yourself and your patients get more sleep. Sleep is immensely important for multiple aspects of immune function.

The virus will evolve, and we will adapt.  At some point, it will resolve.  Right now, many people, especially those in the media, are overreacting.  That is always a mistake.  There has never been a substitute for reason, prudence, and common sense.  Steady as she goes.  How often can you say it?

 

Coronavirus – An Update

Posted Posted in Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Mary O’Brien, M.D.

It’s progressing. We knew it would.

The novel coronavirus, just renamed CoVID 19, has surpassed SARS in the number of deaths caused.

The number of confirmed cases worldwide is 60,081 with 1363 deaths. Nearly 99% of cases are still in China and the mortality rate remains around 2‒3%. There are undoubtedly far more unconfirmed cases in China since large numbers of people are at home with mild to moderate symptoms, or even asymptomatic infection. Inadequate testing to confirm the virus or rapidly triage and admit patients to intensive care in Chinese hospitals appears to be a serious problem.

The Chinese physician who first recognized an outbreak of SARS-like illness was targeted and arrested for “rumor-mongering.” He was even forced to recant his story. Dr. Li Wenliang contracted the coronavirus and died last week. Even his death was denied by authorities for a day. Dr. Li joins a brave, dedicated, compassionate group of heroic physicians throughout history who succumbed to the very illness they were treating. His memory will be honored.

The only way to solve a serious problem is to address it in an open, straightforward manner. Secrecy rarely solves serious problems. We’ve all heard the old dictum, “Sunlight is the best disinfectant.” Fortunately, the President’s task force on the coronavirus has done an excellent job of educating the public, securing and screening ports of entry, coordinating distribution of viral test kits to U.S. labs, evacuating Americans from China, and quarantining appropriate people with possible exposure.

The CDC, NIH, and Department of Health and Human Services personnel are working nonstop to contain the virus and develop a vaccine and potential treatment. In the meantime, supply chain disruption is affecting car companies, tech firms, and even medical supply businesses. Many of our OTC and prescription medications, including antibiotics, are made in China. The FDA has evacuated our personnel who inspect these production plants. There may well be consequences in the coming weeks and months here in the U.S.

Meanwhile, we’re in peak cold and flu season. Fastidious hygiene remains key:

  • Wash your hands – frequently and with soap and hot water for at least 20 seconds.
  • Do not touch your mouth, nose, and eyes. Viral particles suspended in respiratory droplets can penetrate mucous membranes and conjunctiva very easily.
  • Maintain at least 6 feet between yourself and others (social distancing)
  • Avoid crowds and unessential travel
  • Get more sleep than you think you need
  • Stay home if you have cold or flu symptoms (and don’t lay a guilt trip on colleagues who are sick)
  • Disinfect hard surfaces frequently. This coronavirus can apparently survive on hard surfaces as long as 9 days. Phones, keyboards, bathroom fixtures, door handles, and steering wheels are just a few examples.

Seasonal epidemics triggered by a mutated virus can be devastating, but eventually they are contained. Until then, our job is to stay calm, stay informed, and practice the time-tested principles of good patient care and common sense.

All the Little Warning Signs

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

By Mary O’Brien, M.D.

A friend of mine died last week from cancer. She was 52 years old.  Few people knew how seriously ill she was.  She didn’t want pity.  She didn’t even want sympathy.  The only thing she wanted was exuberance in life and dignity in death.  She successfully achieved both.

Sitting in the back of the church and listening to her eulogy, I wondered how many people struggle silently with serious illness and stress.  I suspect every one of us knows people who, despite their poise and polish, suffer tremendous personal anguish that remains hidden from the world.  They function day to day scarcely skipping a beat.  They’re the first ones to lend a hand when someone else is in a jam and they hardly ever grumble or gripe.  Other folks tend to dump extra work in their laps because they’re so good-natured and conscientious.

Then one day, overwhelmed by stress, illness, depression, or exhaustion, these selfless stoics collapse.  Nearly everyone in their sphere of influence is shocked because they failed to notice all the little warning signs.  Somehow it was so easy to overlook the growing fatigue, the waning enthusiasm, or the uncharacteristic irritability.  I’d like to say that doctors are usually expert at recognizing the subtle signs of serious illness and stress.  But the truth is, most of us are not.  Doctors, by and large, are so accustomed to chronic exhaustion in their own lives, they often overlook it completely in others.  There is no laboratory test for stress and no scan will screen for exhaustion.  It takes time and concern and insight to detect the subtle signs of serious stress.  And while many of us may be interested in the well-being of others, few of us take the time to develop true insight into other people’s problems.

Maybe if we all slowed down long enough to notice a friend’s fatigue or a colleague’s quiet mood, we could do something helpful before it is too late.  Maybe if we stopped placing so many unreasonable demands on one another, we wouldn’t be plagued by chronic fatigue and burnout.  Maybe if we made an effort to be more friendly and flexible in our daily encounters, folks would feel free to ask for help when they need it.

It would be wonderful if teachers and preachers and bosses and bureaucrats would promote empathy and compassion as much as they promote rules and regulations.  But until patience and kindness work their way into the culture’s curricula, we’ll have to rely on the insight of individuals.

Do you know someone who’s overwhelmed, worn out, dejected, or depressed?  Be gentle with him or her.  Cut such people some slack.  They may be up against serious stress or illness.  Be kind to them and to everyone you encounter today.  You may not have the chance to be kind to them tomorrow.

Passport to Health? Maybe not…

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Pain, Psychology

By Mary O’Brien, M.D.

“It relieves headaches, insomnia, anxiety, depression, arthritis, fibromyalgia, and pain of all kinds.” Sounds great. Unfortunately, this is merely an excerpt from an ad for CBD oil. CBD stands for cannabidiol, a non-psychoactive molecule that has some documented anti-oxidant, anti-inflammatory, and anxiolytic properties. CBD products and stores are popping up all over the country. Even the business networks are covering possible investment opportunities. CBD products now include teas, tinctures, topical creams, pills, oral solutions, sprays, candies, cookies, gummies, chocolates, and Italian ice. No kidding.

The vast majority of studies on CBD are preclinical, animal studies (mostly rats). Trying to extrapolate research findings from rats to humans is not medically sound. It can also be downright dangerous. But many people have a stunning ability to believe what they want to believe.

We live in an age of narrative. The narrative about far too many topics is carefully crafted by self-proclaimed elites in the media, the entertainment industry, the political realm, and the academic world. Money is a critical factor in forming a narrative, but equally vital is the perception of being “cool.” Being perceived as “cool” is of the utmost importance to a staggering number of people. The really “cool” people don’t even realize they’re cool because they’re too busy pursuing truth and genuine accomplishment.

When it comes to a fad like CBD, the prudent people are open-minded but cautious. Centuries of experience in numerous cultures should have taught us something about con-artists and snake oil. Some of our grandmothers were certain that a dose of castor oil every week would cure anything. Millions of people in Asia still believe the rhinoceros horn can heal everything from impotence to cancer. And despite all our science, people still spend ridiculous sums of money on ground apricot pits and crystals in place of chemotherapy.

The actual pharmacologic effects of CBD products are still being evaluated. Standardization, purity of product, dosing, absorption, bioavailability, half-life, potential contraindications, adverse effects, and drug-drug interactions need to be elucidated -– in people, not rats.

Until then, be careful. Snake oil salesmen abound, and they’ll probably seem really “cool.” Buyer beware. CBD Italian ice is likely not your passport to health.

homestudy

Spotlight on Eggs

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

By Dr. Laura Pawlak

The hard-boiled egg, a breakfast omelet, and fancy deviled eggs — these are favorites among Americans. Eggs are also a good source of protein, along with meat, fish, and poultry.  But, is the egg considered a healthy choice?

In 1980, the U.S. Department of Agriculture began releasing dietary recommendations for Americans with a focus on cardiovascular health.  Dietary cholesterol was stated as a major contributor to heart disease.  Eggs, the number one source of cholesterol in the diet, took the spotlight.

While dietary cholesterol can be found in all foods derived from animals, one egg has about 200 mg. of cholesterol while a serving of beef, pork, or chicken has less than 100 mg. per serving.  The dietary limit for cholesterol (300 mg. per day) significantly limiting the choice of egg-based meals and snacks.

Decades of research have led to a very different interpretation of the role cholesterol plays in heart health.  There was no direct evidence to support the link between egg consumption and blood levels of cholesterol — the risk factor for heart disease. The liver produces most of the cholesterol measured in the blood.

By 2015, dietary cholesterol was no longer considered “the nutrient of concern” for healthy people. New dietary guidelines reflected an emphasis on whole foods, rather than individual nutrients.  For example, fish provides essential omega-3 fatty acids and protein, not just cholesterol.  Red meat contains multiple substances beyond cholesterol that negatively affect heart health.

Eggs made a comeback, but included a warning to eat eggs in moderation — only one or 2 eggs per day. Further restriction was recommended for persons with Type 2 diabetes:  Limit eggs to four per week.

This year, new research by Victor Zhong and colleagues (Journal of the American Medical Association, 2019) rekindles the debate about the role of dietary cholesterol from eggs and red meat in cardiovascular disease and all cause mortality, but official guidelines remain unchanged.

According to Dr. Frank Hu, of the Harvard School of Public Health (2019), “For persons who are generally healthy, eat fruits, vegetables, whole grains, nuts, and legumes and lower [the] consumption of red and processed meats and sugar.  A low to moderate intake of eggs can be included as part of a healthy eating pattern, but they are not essential.  There is a range of other foods one can choose for a variety of healthful breakfasts, such as whole grain toast with nut butter, fresh fruits, and plain yogurt.”

____________________________________________________________________________
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.

 

A Heroine of the Highest Order

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

By Mary O’Brien, M.D.

Media reports described her as merely “an older woman.”  The implications are obvious.  “Older woman” translates into commonplace, generic, ordinary, and unimportant.  Nothing could have been further from the truth.  Lori Gilbert-Kaye was the 60-year-old lady who threw herself between the vicious 19-year-old gunman and the rabbi at the synagogue shooting in Poway, California.

Members of the congregation were observing the final day of Passover when they were attacked by unbridled evil.  Lori Gilbert-Kaye gave her life to save her rabbi. There is nothing commonplace, generic, ordinary, or unimportant about that.  Rabbi Goldstein described her valiant action at a deeply moving ceremony in the Rose Garden on the National Day of Prayer.  He lost several fingers in the horrific attack, but his wisdom, insight, courage, and compassion were only highlighted in the process.  He honored Lori Gilbert-Kaye in his brief but eloquent remarks.  A march in her honor is scheduled for early June.  No doubt many people will learn more about this kind, generous, devoted, and heroic “older woman.”

Is there something those of us in health care and education can learn from all of this?  Indeed, there is.  People have names.  They are not merely generic patients, students, or account numbers.  They are not simply old ladies or cases or room numbers.  Every human being has an identity, a personal story with challenges, heartaches, triumphs, and loved ones.  A woman who instinctively gave her own life to save another deserves to be known and remembered by her name.  Lori Gilbert-Kaye was heroic in life and in death.  She set a beautiful example for our nation.

Most of us will never have to make the split-second decision to sacrifice our own life to save that of another.  We do, however, have an opportunity everyday to honor others by using their proper names.  Lori Gilbert-Kaye was far more than an “older woman.”  She was a heroine of the highest order.

An Old-Fashioned, Counter-Cultural Approach

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

By Mary O’Brien, M.D.

Are you already worn out from holiday activities?  There is Thanksgiving travel, Black Friday, Cyber Monday, and reports of morning, noon, and night sales hitting record levels.  The cold and flu season is well underway, and millions of Americans are totally tuckered out.  They will, nonetheless, try to sustain this frenetic activity for another month.  There is an alternative, old-fashioned, counter-cultural approach.  It’s called Advent.

Long, long ago, before people had electronic devices surgically implanted into the palms of their hands, they observed a quiet, disciplined period of waiting for Christmas.  The word, “Advent,” is from the Latin word “adventus,” referring to the arrival of a significant person, time, or event.  Over the centuries, Christians developed the practice of spending the four weeks before Christmas in prayer, fasting, and giving alms to the poor.  It was a way to discipline themselves, physically and spiritually.

Many of our grandparents were very serious about this tradition.  They waited to put up a tree and decorate it until Christmas Eve.  The 12 days of Christmas were actually celebrated from Christmas Day to January 6th, the Epiphany, or arrival of the three Wisemen.  Today, Christmas-in-July sales have us in major shopping mode for half the year.  Many people are tired of Christmas long before it arrives.  By the time credit card bills arrive in late December, very few people are ready for any sort of Epiphany, spiritual, or otherwise.

There are some healthy, helpful things any of us can do in the spirit of Advent.  Most folks want to find meaning in their lives that extends beyond acquiring money, stuff, and titles.  Nonstop, frantic striving can only distract us for so long.

  • Before the holiday craziness consumes any more of your mental, physical, emotional, or spiritual energy, consider a slightly different approach to December: “Fast” from all electronics for one hour a day (while you’re actually awake).  This will reveal volumes about where you are in life.
  • Practice the old-fashioned discipline of giving up candy, sweets, desserts, etc. The first bite of your favorite holiday treat will taste heavenly.  Chances are good that you’ll drop a few pounds in the process.
  • Avoid spending money on fancy coffee, eating out, alcohol, and other little indulgences; give the money you save to help a family devastated by the recent natural disasters.
  • Do something nice for someone else — anonymously.
  • Do something nice for someone you really can’t stand.
  • Invest 15–25 minutes each day in prayer, meditation, contemplation, or spiritual reading to focus on what matters most to you.
  • Make a serious effort to replace cynicism and sarcasm with gratitude and gentleness.

If all of us did even half of these things for a few weeks, the ripple effect would be immense.  Advent.  It’s an old-fashioned, counter-cultural approach.

A Circle of Prayer

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars
Credit: National Review

They knelt in prayer and grief.  A dozen brave, dedicated, selfless firefighters and rescue personnel in Wilmington, NC were heartbroken on sight.  A mother and her 8-month old baby girl were killed when a tree crashed through their house during Hurricane Florence.  The father was severely injured and rushed to the hospital.  Upon completion of their agonizing task, the first responders were captured in a photo kneeling in a circle of prayer.  Within hours, the image went viral and millions felt their anguish.

Suffering and heartache are rampant here in the Carolinas now.  It will take many months and even years for people to recover from the devastation.  This part of the country has been my home for many years and my heartfelt thoughts and prayers go out to everyone in need.  I know that everyone at INR joins me in that circle of prayer.  To all our customers and colleagues who have worked with us for so long, we wish you Godspeed in your recovery.

Note to Self

Posted 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.