Random Acts Of Coolness

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

by Mary O’Brien, M.D.

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

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

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

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

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

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

Anxiety

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

By Barbara Sternberg, Ph.D.

A basic human emotion, anxiety is the sensation of worry, fear, apprehension, panic, tension, or unease that occurs in response to situations that seem overwhelming, dangerous, threatening, or distressing.  Manifesting in such forms as worry prior to a major test, nervous anticipation of a social occasion or business event, or heightened alertness in the face of apparent peril, anxiety is an intuitive recognition that action of some kind should be taken.

Anxiety that prompts appropriate action is a normal, adaptive response to temporary stress or uncertainty.  Detrimental anxiety overwhelms the individual experiencing it, preventing appropriate action or producing counterproductive responses.  Prolonged, intense, or inappropriate worry that interferes with normal function or that is a source of significant emotional or physical distress may signal the presence of an anxiety disorder.  Free-floating anxiety that occurs in the absence of an external threat and is pronounced enough to impair daily function may also be symptomatic of an anxiety disorder.

An estimated 40 million Americans over 18 years of age — about 18 percent of the adult population of the United States — experience anxiety disorders.  In contrast to relatively mild transient anxiety induced by a stressful event like public speaking or a first date, anxiety disorders persist for six months or longer and can worsen without treatment (NIMH). According to the National Comorbidity Survey Replication, overall lifetime prevalence of anxiety disorders in the U.S. is 28.8 percent, meaning that more than one out of every four adults experiences at least one anxiety disorder during his or her lifetime. Anxiety disorders are approximately twice as common in women as in men. Most people who are affected by anxiety disorder have more than one, and nearly 75 percent of those who have an anxiety disorder experience their first episode by the time they reach 21.5 years of age.

Although anxiety disorders are highly treatable, only about one third of those with these disorders receive treatment.

Coping with Anxiety

Although evidence indicates that early treatment of anxiety disorders can prevent such complications as depression and severe phobic avoidance, only about one victim in four ever seeks medical help. Recommended self-help strategies for anxiety management include:

  • maintaining perspective.
  • being informed.
  • having a positive outlook.
  • building resilience.
  • creating a social network.
  • seeking help when necessary.

When personal anxiety management proves ineffective, a family physician can help determine if symptoms are caused by an anxiety disorder, another medical condition, or combined factors.  Coexisting medical conditions may have to be treated or brought under control before the anxiety disorder can be addressed, by a psychologist, psychiatrist, social worker, or counselor. Some people with anxiety disorders must try several treatments or combinations of treatments before finding one that relieves their distress.  Medications do not cure anxiety disorders, but antidepressants, anti-anxiety drugs, and beta-blockers may control some physical symptoms while the patient receives psychotherapy.

Minimizing Summertime Maladies

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

By Mary O’Brien, M.D.

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

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

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

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

Obsessive-Compulsive Disorder

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

By Barbara Sternberg, Ph.D.

Occurring in men and women with comparable frequency, obsessive-compulsive disorder (OCD) affects about 2.2 million Americans 18 years or age and older — one percent of the adult population of the United States.  Initial symptoms usually manifest themselves in childhood, adolescence, or early adulthood, and median symptom onset is 19 years of age.  One third of adults with OCD experience their first symptoms as children.

 OCD is characterized by repetitive, intrusive, unwanted, and disturbing thoughts known as obsessions and by the performance of rituals known as compulsions — in an urgent attempt to control the anxiety that the obsessions generate.

Fear of social embarrassment, for example, could prompt someone with OCD to comb his or her hair so compulsively that the individual becomes unable to look away from the mirror.  Thoughts of engaging in violence, bringing harm to loved ones, and having a persistent preoccupation with performing distasteful sexual acts or violating one’s religious beliefs are common obsessions.  Common rituals include repeated hand-washing, counting, or touching objects (especially in a particular sequence).

People who have OCD may be preoccupied with order and symmetry, have trouble discarding things, and accumulate or hoard things they don’t need.  Healthy people perform such rituals as repeatedly making sure the stove is off before leaving the house.  People with OCD perform rituals that distress them, interfere with daily life, and provide no more than a temporary respite from their obsession-induced anxiety.  Most people who have OCD are eventually enslaved by their own compulsions. 

Research indicates that OCD may be a familial disorder.  Many adults who have OCD recognize the futility of their actions, but children and some adults who have OCD are unaware that their behavior is unusual.  The course of OCD can vary.  Symptoms may emerge and disappear, ease or intensify, or prevent the individual from carrying out his or her responsibilities.  Many people with OCD try to control their disorder by avoiding circumstances that trigger their obsessions or by self-medicating with alcohol or drugs.

 

The Healing Power of Touch

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

By Mary O’Brien, M.D.

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

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

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

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

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

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

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

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

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

The Sounds of Silence

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

By Mary O’Brien, M.D.

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

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

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

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

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.

 

Mood and Food

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

What you eat can affect your risk of the most common mood disorder in the United States:  depression.

Mental health begins with lifestyle:  nutritious food; regular exercise; sufficient sleep; and coping skills.

The chemical components of food impact one’s state of mind throughout the day — that is, after every meal and snack.  A long period of time without nourishment (fasting) activates survival emotions throughout the brain.  Food, or the lack of it, thus alters both feelings and thoughts.

A significant part of the treatment program for patients with depression is a brain-healthy diet prescription designed by what may be termed a nutritional psychiatrist.  Clearly, changing one’s eating habits requires more time and energy than swallowing a pill.  However, research in mental health has appeared, showing the flaws of prescribing quick-fix medications — in the absence of healthy habits.

A recent study published in BioMed Central Medicine tested the effect of prescribing both a modified Mediterranean Diet and medication to treat patients with clinical depression.  Thirty-three percent of the patients given medication plus a modified Mediterranean Diet plan achieved remission in 12 weeks.  However, eight percent of the patients prescribed medication only reached remission in the same period of time. (Study by S. Reddy, January, 2017)  This mood-enhancing cuisine is highly concentrated in brain-protective foods:  fruits; vegetables; legumes; whole grains; raw, unsalted nuts; low-fat, unsweetened dairy foods; olive oil; and fish.

The positive effects of nutrition intervention reported in this study have encouraged psychiatrists to prioritize this diet prescription for all patients diagnosed with depression.  The modified Mediterranean food plan may help prevent the incidence of depression in persons at high risk, aid patients who reject medication, and may block the progression from mild depression to serious depression.

Regardless of one’s family history, the brain can slip into an imbalanced state that alters mood and mind-power. The wise statement, “You become what you eat,” applies to everyone.  The original Mediterranean cuisine has already scored high ratings against brain atrophy, pain, and all age-related diseases.  The Mind Diet, another modified format of the Mediterranean Diet, reduces the risk of Alzheimer’s disease.

Cook, eat, and share mood-enhancing meals.  It’s a challenge that delivers great rewards for the brain — sharper thinking and happier moments.
_______________________________________________________________________________

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.

Cold Symptoms and Prevention

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

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By Ben Hayes, MD, PhD, FAAD

Cold symptoms generally emerge between one and three days after a cold virus enters the body.  The symptoms resolve in a week — with or without medication. One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health. Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than five percent of colds lead to such complications as bronchitis, middle ear infection, or sinusitis accompanied by a prolonged cough, but between 5 and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum. A cold can produce wheezing, even in children who do not have asthma, and symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks. Symptoms that persist for more than two weeks or that recur might be more allergy than infection-related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician.  Medical attention is indicated if symptoms progress to:

  • ear pain.
  • high fever.
  • a cough that worsens as other symptoms abate.
  • a flare-up of asthma or of another chronic lung problem.
  • significantly swollen glands.
  • strep throat.

Babies can have between five to seven colds during their first two years of life. This enhanced susceptibility results both from immature immune systems and from exposure to older children who are often careless abut washing their hands or covering coughs and sneezes. Nasal congestion and runny nose are the most common symptoms of colds in babies. Treatment consists of breathing moist air and drinking plenty of fluids. Medical attention is indicated at the first sign of a cold in infants less than three months of age because of a heightened risk for pneumonia, coup, and other complications.

Physician evaluation is also necessary if a baby of any age:

  • has an uncomplicated cold, the symptoms of which last for more than seven days.
  • does not wet a diaper properly.
  • refuses to nurse or accept fluids.
  • coughs up blood-tinged sputum or coughs hard enough to cause vomiting or changes in skin color.
  • has trouble breathing.
  • has bluish-tinted lips or mouth.
  • has a temperature higher than 102°F for one day.
  • has a temperature higher than 101°F for more than three days.
  • shows signs of having ear pain.
  • has reddened eyes or yellow eye discharge.
  • has a cough or thick green nasal discharge for more than a week
  • has any other symptoms that concern parents and/or caregivers

Prevention

Common sense plays an important part in preventing the common cold. Absolute avoidance of cold viruses is virtually impossible to achieve, but experts advise keeping a healthy distance from anyone who is ill. The actions the human body takes to clear infection are the same actions that spread the infection to others. Sneezing, for example, is a response to irritation of the nose and mouth. Sneezing as well as a runny nose is the body’s attempt to expel cold viruses before they can invade the nasal passages more deeply. Unfortunately, a sneeze sends infectious particles hurtling through the air at a speed of more than 100 miles an hour.

Simply being in the company of someone who has a cold can contaminate the hands of another person. Touching one’s eyes, nose, or mouth can transfer the infection. It is imperative to wash hands thoroughly after touching someone who has a cold or something that has been touched by someone who has a cold. Playthings touched by a child who has a cold should be washed before being put away. Cleaning surfaces with antiviral disinfectant may help prevent the spread of infection, and increasing interior humidity can reduce susceptibility.

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