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.

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?

 

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.

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.

Vitamins & Minerals: What Does The Body Need?

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

By Annell St. Charles, Ph.D., R.D., L.D.N.

In 1912, Casimir Funk, a Polish biochemist, isolated a concentrate from rice polishings that cured polyneuritis in pigeons.  He called the substance a “vital amine” or “vitamine” because it appeared to be vital for life.  There was widespread interest in eradicating several prevalent diseases at the time, and, in an article published in 1912, Funk postulated the existence of four substances:  one that prevented beriberi (“antiberiberi”), one that prevented scurvy (“antiscorbutic”), one that prevented pellagra (“antipellagric”), and one that prevented rickets (“antirachitic”).  Funk was one of several researchers in the early 20th century investigating these and other substances and their connection to health.

Epidemiologists, physicians, physiologists, and chemists all worked on this puzzle through the mid-20th century; the work was slow and onerous and plagued by many setbacks and contradictions.  Chemists were the ones ultimately able to identify and isolate the substances we call vitamins, leading to the development of synthetic forms that are available for wide consumption.  The proposed benefits and risks of vitamins and vitamin supplementation continue to be hot topics today.

The vitamins needed by the body for growth and normal development are:

  • Vitamin A
  • B Vitamins (vitamin B6, vitamin B12, folate, and others)
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Vitamin K

Vitamins are divided into two groups:

  • Water-soluble are easily absorbed by the gut and stored only minimally. These include Vitamin C, thiamin, riboflavin,niacin, biotin, pantothenic acid, B6, folic acid, B12, and others.
  • Fat-soluble are stored in body tissues and excess accumulation can be toxic.  Vitamins A, D, E, and K are fat-soluble vitamins.

Macrominerals & Trace Elements

These essential inorganic elements are categorized by abundance:

  • Macro-minerals are present in the body over 100 mg:  calcium, phosphorus, magnesium, potassium, sodium, chloride, and sulfur.
  • Trace elements are present in microgram or low-milligram amounts:  iron, zinc, iodine, selenium, copper, manganese, fluoride, chromium, molybdenum, silicon, nickel, boron, arsenic, tin, and vanadium.

After The Storm

Posted on Posted in Brain Science, Elder Care, Homestudy, Psychology

By Mary O’Brien, M.D

A week of frightening forecasts.  Days of hectic, worried preparations.  Hours of terrifying wind and torrential rain.  Now nearly seven million Floridians are without power.  They, along with millions of other people, will begin the long process of recovery.  Despite their exhaustion and stress, they will follow in the footsteps of so many Texans and help one another.  People in Florida are not strangers to disasters.  They know how to re-build.

And who, among the rest of us, does not know someone in Texas or Florida?  Nearly every individual I know has family members, friends, colleagues, or acquaintances in one of these disaster-ravaged areas.  We are all interconnected whether we realize it or not.  Those of us in health care who are well-acquainted with suffering have an opportunity to set a good example for others.  Whatever each of us can do to help, now would be a good time.

To Our Friends And Colleagues In Texas

Posted on Posted in Elder Care, Psychology
credit CNN

How do you cope with a year’s worth of rain in a few hours? It’s like anything else in life: Until you’ve been through it yourself, you don’t know. Some of us scattered across the country have vivid memories of Superstorm Sandy or hurricanes like Andrew, Hugo, or Katrina. I remember all too well what Hurricane Floyd, in the late 1990’s, did to my house in coastal North Carolina. Water poured into my kitchen and living room, ruining my furniture and morale. I was on call at the time. At one point, all I could do was cry. That was a result of 22 inches of rain in 24 hours. How anyone copes with 50 inches of rain is beyond my comprehension.

The days, weeks, and months ahead of you will be brutal. At some point, nearly everyone will feel overwhelmed with exhaustion, anguish, anger, and frustration. Many of you will wear yourselves out while helping others. That’s what good people do in a crisis.

Throughout the U.S. and Canada, there are many good people who frequent INR (Institute for Natural Resources) and Biomed seminars. Perhaps it will give you a miniscule measure of comfort to know that you are in our thoughts and hearts and prayers. Across the country, the number of people in schools, businesses, religious groups, and civic organizations contributing to relief efforts is growing. One day all of this will be behind you. Until then, may you all be blessed with the safety of your loved ones, compassion for one another, and Texas-sized resolve.

Diet and Alzheimer’s Disease

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

What weighs a mere four pounds and has a workload that demands 20 percent of all the oxygen inhaled?  Answer:  the human brain.

As technology opens the door to the unique metabolic functions of the brain, scientists are investigating the nutrients required to keep mentally sharp over the decades.

With dementia rising at an alarming rate — along with obesity, diabetes, heart disease, and other ailments — let’s eat with purpose, using sound, nutrition-related science applicable to the brain and the rest of the body.

Starting with the belief that what we eat plays a significant role in determining who gets dementia, Martha Clare Morris, Ph.D. and colleagues developed the MIND Diet as an intervention against the most common cause of neurodegeneration:  Alzheimer’s disease.

The work of Morris and her colleagues is based on research completed at Rush Medical University in Chicago, Illinois.  The term “MIND” is an acronym for Mediterranean-DASH Intervention for Neurodegenerative Delay.

The DASH diet plan is based on research sponsored by the U.S. National Institutes of Health.  The plan was developed to lower blood pressure without the use of medication.

The Mediterranean and DASH diets are models of healthy eating for the body.  The Morris team chose foods that improve brain function significantly and also added to overall body wellness.

Adherence to the MIND diet may lower the risk of Alzheimer’s disease by as much as 53%, offering more protection for the brain than any other dietary regimen.

The MIND cuisine lists 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine).  The plan limits consumption of five brain-unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, and fried or fast food).

The plan suggests a minimum of three servings of whole grains, a salad, and one other vegetable every day — along with a glass of wine.  For snacks, add a variety of nuts.  Berries are the only fruits recommended.

Specifically, blueberries are noted as the powerful protectors of the brain.  Strawberries are a second choice for good cognitive function.

Use Google and enter the term “MIND Diet” for daily guidelines and recipes of a cuisine designed to maximize brain function while providing healthy foods for the rest of the body as well.


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.

 

Influenza

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

By Raj Hullon, M.D., J.D.

The flu is a contagious infection that affects the nose, throat, and lungs.  Onset is more abrupt compared to the common cold.  Symptoms can range from mild to severe, even leading to life-threatening complications.  Nausea, vomiting, and diarrhea are more common in children than in adults.  Other flu symptoms include:

  • fever (usually high).
  • extreme fatigue.
  • dry cough.
  • sore throat.
  • nasal congestion or runny nose.
  • muscle aches.
  • impaired sense of taste and smell.
  • loss of appetite.

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 people are hospitalized for treatment of flu-related complications.  Approximately 36,000 deaths a year result from flu-related causes in the United States (cdc.gov).

Seasonal flu refers to any of the combinations of influenza viruses that circulate throughout the world each year.  The flu season in the United States can begin as early as October and run through March.  The Center for Disease Control (CDC) tracks circulating flu viruses and related disease activity all year and, between October and May, provides weekly influenza updates at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.   Pandemic flu refers to a global outbreak of flu that can overwhelm the health care system.  The cause is most likely a strain of influenza virus that is new or that has not circulated recently enough for large portions of affected populations to have built up gradual immunity to it.  Therefore, healthy individuals are at risk for complications following infection during a pandemic flu outbreak.  Seasonal flu, however, usually leads to fewer complications in healthy adults.  During the 1918 pandemic, for example, the estimated deaths from the disease and disease-related complications reached 20 to 40 million individuals globally. Fortunately, pandemic flu outbreaks are rare.  There were only three pandemic outbreaks in the 20th century while seasonal flu is annual and peaks in January or February.