Pop Quiz!

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

By Mary O’Brien, M.D.

Quick!  What illness can cause fatal pneumonia, bacterial superinfection, meningitis, myelitis, encephalitis, acute thrombocytopenic purpura, transient hepatitis, or subacute sclerosing panencephalitis?  The answer is measles.  Each year nearly 20 million people are infected worldwide.  There are 200,000 deaths, most of which occur in children.  The anti-vaxxers are utterly unaware of these facts, but there has never been a shortage of ignorance in the world.

Measles is a highly contagious viral illness that typically strikes children. Unfortunately, more than 90 percent of susceptible people who are exposed will contract it.  Measles spreads mostly by aerosolized droplets from the nose, throat, and mouth during coughing.  The virus can survive airborne for two hours in closed areas like a classroom.  The vast majority of measles cases in the U.S. are transmitted by travelers and immigrants, with subsequent transmission to unvaccinated children and teens.

Measles has a 7 to 14-day incubation period.  The prodrome begins with fever, sneezing, watery eyes, conjunctivitis, and a hacking cough.  Koplik spots develop on the oral mucosa, opposite the first and second upper molars — before the rash develops.  Dental professionals take note.

A sore throat typically develops shortly before the rash, which is maculo-papular.  Macules erupt just in front of and below the ears, then migrate down the sides of the neck.  Papules begin to emerge as the rash spreads down to the trunk and extremities, including the palms and soles.

Peak severity is often marked by a fever above 40⁰C.  Many children have periorbital edema, photophobia, irritability, pruritis, and a hacking cough. These kids look and feel very sick for 3 to 5 days, at which point the fever subsides and the rash fades and desquamates.  Immunocompromised patients may be profoundly ill with severe, progressive pneumonia but no rash.

Mortality in measles is about 2 in 1000 cases in the U.S. and much higher in developing nations.  In the year 2000, measles was officially declared eradicated in the U.S. by virtue of the tremendously effective MMR (measles, mumps, rubella) vaccine.  Unfortunately, multiple outbreaks have recently occurred in California, Washington, Oregon, Utah, and New York.  Many outbreaks have been linked to unvaccinated children in Amish and Orthodox Jewish communities.  Currently, an outbreak of measles in Brooklyn, New York, has been declared.  There were 285 cases, a public health emergency.  Nationally, the figure stands at 465 cases documented in 15 states.

Scientific ignorance and paranoia on the part of some parents and stunning misinformation on the internet has led to clusters of unvaccinated children and rapid spread.  The original “study” claiming that vaccines cause autism was entirely fraudulent.  It involved 12 patients and was thoroughly debunked.  The author lost his medical license.  Legitimate studies of over two million children have demonstrated absolutely no relationship between vaccines and autism.  Autism has been linked to over 100 genetic mutations.  Many people today do not like to hear the word “genetic.”

A landmark study published several years ago in the New England Journal of Medicine revealed disrupted stratification of multiple cellular layers in the cerebral cortex early on in fetal development.  The stage for autism seems to be established before birth.

Making decisions based on misguided notions and emotions can be catastrophic.  Those of us in health care and education need to set the record straight.

Whoever Shouts The Loudest

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

By Mary O’Brien, M.D.

Can you tolerate watching “the news” these days?  If you’re much over the age of 40, you probably realize we scarcely have any real news programs left.  Nearly every option revolves around opinion, bias, personal and corporate agendas, and ridiculous panel discussions with people shouting over one another.

I’m willing to listen to almost anyone who can discuss the facts of a given topic in a cogent, logical manner.  Sadly, there isn’t much of that on TV or most other venues.  Somehow people have gotten the idea that whoever shouts the loudest or spews the most obnoxious sarcasm wins.

This is frustrating on TV, but it can be even more problematic at work or in social settings.  More and more people dread family gatherings for this very reason. Most of us are fond of work, family, and friends.  So with that in mind, here are a few tips on preserving such gatherings:

  • Be civil and never talk over another person. Remind yourself to disagree agreeably.
  • Always look for common ground. Most people want a safe, happy, healthy life for themselves and their loved ones.  Start with that assumption.
  • Pick your battles. If it won’t matter five years from now, it probably doesn’t matter much now.
  • Listen carefully and actively. Many people today don’t listen much at all, especially on TV.  They’re too busy planning their next snide, sarcastic retort.  Repeat what the other person has said and try to understand his or her perspective.
  • Remain calm. In a debate, the angry person almost always loses.  Very few people in our culture have ever taken a course in logic, ethics, or debate, and it shows.  Be the adult in the room.
  • Don’t aim to prove you’re right and the other person is wrong. Concentrate on the facts and explain them clearly.  Most arguments have nothing to do with facts.
  • Avoid making accusations. Insecure people become defensive very quickly.  Truly knowledgeable, accomplished, mature people have no need to be defensive or even bother with accusations.
  • Never use vulgar language or derogatory terms. Calling someone an idiot will not persuade him that your point is correct.
  • In a tense situation, let the other person blow off steam. A patient or family member receiving bad news can become emotionally volatile and angry.  Let him vent.
  • Watch your physiology. Aggressive body language and irritated facial expressions are usually the mark of an undisciplined individual.  Practice your best Mr. Spock imitation, especially when others are upset.

If you’re young enough and charming enough, and you master these principles, you just might get your own talk show on TV.  I’ll be rooting for you.

Lest Ye Be Judged

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

By Mary O’Brien, M.D.

It occurred to me the other day that I have a peculiar reason to appreciate “retirement.”  It has nothing to do with sleeping in a bit or taking an occasional nap.  It’s completely unrelated to dressing more casually or having a nice cup of tea whenever the mood strikes.  What I was truly enjoying was the notion I had been freed from the onerous task of evaluating other people.  But no!  Last week I had a Salvation Army pick up and the driver handed me an evaluation form.  I was supposed to rate the Salvation Army on promptness, friendliness, and efficiency — among other traits.  The Salvation Army!  I think we’re going overboard here.  I just wanted to donate some clothes.

No doubt anyone in healthcare, law, education, or business knows whereof I speak.  In fact, in recent decades this practice has reached ridiculous proportions.  Faculty evaluate residents who evaluate students who evaluate faculty.  Administrators evaluate managers who evaluate trainees who evaluate the whole system.  Every individual who speaks at a conference, seminar, or lecture is evaluated on everything from the tone of his (or her) voice to the title of his talk.  Filing cabinets and computer databases across America are bursting at their metal and electronic seams with evaluations.

The real question is:  Why do we need to judge one another?  I realize that some form of grading system is necessary through college and various training programs.  But over the past two decades we’ve gone far beyond grades.  We might have developed a national preoccupation with criticizing one another.  I genuinely enjoy giving people good evaluations.  But there are times when a negative evaluation is in order and, frankly, I’d just as soon undergo a root canal.  Every one of us has bad days, bad weeks, and sometimes even bad years.  Wouldn’t it be nice if we could be a bit more understanding?

The process of evaluation can be helpful when it’s geared toward encouragement, guidance, and improvement.  But when it reflects a harsh, critical spirit, nothing helpful happens.  Fighting the tide is not easy.  But I’d like to think that there’s hope.  A very wise man once said, “Judge not, lest ye be judged.”

I gave the Salvation Army people an “A.”

Some Timeless Investment Tips

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

By Mary O’Brien, M.D.

It’s tax time again.  Those little pieces of paper that seem so important to the Internal Revenue Service are arriving in our mailboxes.  It’s a good time to review a few basic tips on money management and investing.  You know, the principles no one actually taught us during our many years of training to save lives.

What does money management or investing have to do with health care?  A lot. Financial worries, either personal or institutional, often compromise patient care.  People can act with “impure motives” if dollar signs cloud their thinking.  Everything we recommend to a patient, client, or student should be in his or her best interest.  Those of us in health care should keep our finances in order so that our motives are honorable.  Working with a fiduciary financial planner is similar.  Such a professional is obligated to do what’s best for his client, not himself or his company.

Keeping all of this in mind, there are some timeless investment tips that apply to almost all of us:

  • Saving and investing are different. Step 1 is to get out of debt. Step 2 is building up an emergency fund of at least three to six months of living expenses.  Then investing can begin.
  • Educate yourself and don’t invest in things that you don’t understand. In our culture you can earn an advanced degree and have no idea how to handle money. The first thing you have to invest is time.
  • Sign up for a 401(k) or 503B plan at work and fund it to the max. Investing each month (with money taken out of your paycheck before you see it) is the best path to security.
  • Watch out for management fees and fund expenses. There is a cost to investing, and awareness is key.
  • Take advantage of time and youth. Shocking numbers of people in their 20s, 30s, and 40s have no investments at all.  Modest, steady, monthly investments in your 20s and 30s can lead you to millionaire status in your 60s.
  • Whether you’ve been investing for six months or six decades, do not make decisions based on fear or greed. What separates most people from their money is emotional overreaction when markets tank.  Anyone who has worked in an ER (emergency room), OR (operating room), or ICU (intensive care unit) knows you cannot save a patient if you panic.  “Steady as she goes” sounds simple, but it’s tough when markets correct as they always do.  Stick it out.  The rebound always occurs.
  • Diversify investments and institutions. Depending on your stage in life, some mix of stocks, mutual funds, bonds, REITS (real estate investment trusts), and CDs (certificates of deposit) is prudent. Never put all of your eggs in one basket — or in one hen house.
  • Don’t fall for hot stock tips, free-dinner seminars, or charming financial sales people.
  • Don’t fuss or meddle too much. Some people cannot leave their investments alone. Occasional adjustments are warranted based on your personal situation and market conditions.  A giant oak will never reach its full potential if it’s transplanted every few months.
  • Be cautious and discipline yourself. People with significant financial assets often develop significant egos. Don’t let brokers take advantage of you by flattering your ego.  Remember the Bernie Madoff scandal.  Unscrupulous people can be master manipulators.

Some combination of hard work, discipline, prudence, and common sense helped you develop your career.  Those same principles can help you secure your financial future.

Don’t Do Anything Rash

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

By Mary  O’Brien, M.D.

Are you feeling upbeat and happy?  Have you looked at your end-of-the-year financial statements and credit card bills?  Most of us are feeling a bit tense and dismayed these days.  But take heart.  The markets have improved since Dec. 31, 2018 and your statements aren’t as bad as they look.

This is actually an excellent time to re-group financially and protect yourself from further chaos.  High frequency trading and complex algorithms contribute to frightening volatility on Wall Street.  A single comment from a government official can trigger 800-point swings on the Don Jones Industrial Average.

However, there are a few prudent principles that still work and may well save your sanity.

  • Get out of debt! This requires a daily commitment, but it’s worked in countless cultures for thousands of years.  Since financial security has a massive impact on health and emotional well-being, learning how to save money and reduce debt are crucial.
  • Don’t spend more than 25% of your monthly income on housing. No one “needs” or “deserves” top-of-the-line everything.  For 40 years, I’ve watched my fellow physicians fall into this trap.  And it is a trap.
  • Don’t even think of buying a house or condo if you can’t put at last 20 percent down. Aim for a 15-year mortgage.  It will not double your payments.  It makes no sense to end up house-poor because you’ve made a bank rich.
  • Stop buying or leasing new cars. Buy a used car or dealer-program car, take care of it, and drive it for 10 to 12 years.  I kept my last car for 22 years.  It was just fine.
  • Don’t be an impulse buyer. We can all live without much of what we have.  Consider the people who lived in Paradise, California, or the panhandle of Florida.
  • Don’t waste money on eating out or ordering restaurant food in until you’re completely debt free.
  • Stop wasting money on fancy coffee drinks and alcohol. Both your wallet and your waistline will benefit from these two steps alone.
  • Never buy anything to impress other people. If your friends are impressed by your Smartphone or your handbag, you need better friends.
  • Stop indulging yourself with excessive spending on hair, nails, facials, massages, etc. Many young women fall into this trap, especially if they pay attention to “beauty influencers” on social media.  You are capable of taking care of your own grooming.
  • Resist the temptation to go on vacations or indulge in entertainment until you have eliminated all debt. Millennials like spending money on “experiences.”  I recommend the experience of being debt-free.

Finally, use the money you save to build up an emergency fund of three to six months of living expenses.  Twelve months are better.  For most people, this should be at least $10,000.  Shocking numbers of people can’t afford to miss a single paycheck — just ask the folks affected by the partial government shutdown.

Next time, we’ll tackle some tips on investing wisely.  Until then, don’t do anything rash.

Not for Party People

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

By Mary O’Brien, M.D.

Another year is drawing to an end.  All across the country, folks are stocking up on beer and bubbly for their New Year’s celebrations.  Parties and parades, festivities and football will steal the limelight for a few short days.  But before long, the frivolity will fade and people will settle into their dreary routines.  New Year’s resolutions will be broken as quickly as they were born.  Soon another year will slip silently into oblivion.

All of this can get downright depressing if you really stop to think about it.  I mean — have you ever taken time at New Year’s to evaluate your life?  Are you accomplishing your goals and living your dreams?  Do you even remember what your goals and dreams are?  What wonderful things did you accomplish this year?  Are you a better person than you were 12 months ago?

I take these questions very seriously.  But then, I’m not a party person.  New Year’s has always been my time for taking a personal inventory, a self-assessment of growth and progress.  Having worked with older patients for decades, I’m convinced this exercise is not in vain.  People don’t stay in neutral long.  They either move forward, or they slide into reverse.  But the laws of physics hold fast.  Going in reverse is no problem.  It’s easy and requires no effort.  Going forward requires thrust or energy.  And each one of us must supply our own.

Conducting an annual self-assessment will not appeal to whiners and wimps.  And it’s probably not for party people.  It demands integrity, self-discipline, and drive.  After all, the whole point of this exercise is propelling oneself toward some pretty lofty goals.  Blaming others or the culture for one’s own faults and failures defeats the purpose.

Each of us has different challenges, circumstances, and goals.  My self-assessment questions have served me well over the years.  You may need to amend them, but see if they don’t get you thinking:

  1.  How many books have I read this year?  Did they really sharpen my thinking?
  2.  What are the most important lessons I learned?  Have I put them into practice?
  3.  Did I take good care of my body and health?
  4.  Did I give my family the time and attention it needed?
  5.  Have I learned a new skill or expanded my fund of knowledge?
  6.  Have I further developed a talent I already have?
  7.  Did I devote enough time to my spiritual life?
  8.  Did I try to make life better for others?
  9.  What did I do to invest in my future?
  10.  When I reap what I’ve sown, will I be happy with the results?

This New Year’s review may not be as scintillating as champagne or as fun as football.  But its effects will last a lot longer, and you won’t wind up with a headache!

It’s Almost Here!

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

By Mary O’Brien, M.D.

It’s almost here.  The lines in stores are growing longer and the traffic is becoming heavier.  Yes, it looks as if the annual Christmas crunch is upon us.  Before long, tired travelers will descend upon weary relatives and everyone will feign a friendly, festive front.  By the month’s end, bulging waistlines will battle burgeoning credit card bills for the top spot on the list of holiday headaches.

It seems to get worse with each passing year, and yet sensible solutions elude us.  Which customs would we cut?  Whose relatives would we not visit. What expenses should we forego?  Is it possible just “to say no?”

In recent years, I’ve learned to do precisely that.  After one too many miserable holidays attempting to accommodate everyone, I finally found a better solution.  I simply do what seems — sane.  Some might say my solution seems silly, but you can judge for yourself.  The following are my custom-made commandments for a calm Christmas.

  • Thou shalt not spend more than thou hast.
  • Thou shalt do thy Christmas shopping in September.
  • Thou shalt mail Christmas cards and packages early.
  • Thou shalt honor thy need for quiet time.
  • Thou shalt not be pressured to party.
  • Thou shalt not suffer the company of negative relatives.
  • Thou shalt read something inspiring each day.
  • Thou shalt eat less than thou wantest.
  • Thou shalt not covet thy neighbor’s decorations.
  • Thou shalt do something nice for thy neighbor each day.

I’m particularly partial to that last one.  How different would Christmas be, if everyone all over the world, did something unexpectedly nice for someone else everyday?  Something tells me that’s a lot closer to the true meaning of Christmas than overloaded credit cards and unrestricted appetites.  Silent night.  Holy night.  All is calm.  All is bright.  Maybe there’s a message in those simple lyrics.  I’d like to think so.

 

An Old-Fashioned, Counter-Cultural Approach

Posted on 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 Little Extra Thoughtfulness

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

By Mary O’Brien, M.D.

It’s coming.  The busiest travel time of the year is nearly here.  Thanksgiving is next week, and we’ll be bracing for impact.  Tens of millions of people will go somewhere they don’t really want to go and will do things they don’t really want to do — in some cases with people they may not even like.

Painful delays at airports, agonizing congestion on highways, bad weather, stress, and exhaustion will give a green light to viruses everywhere. Welcome to the cold and flu season.  It might be prudent to rethink a few things.

Despite a strong economy, this has been a very tough year for many people.  Historic flooding, catastrophic hurricanes, terrifying tornadoes, and hellish wildfires have inflicted untold suffering and loss.  Mass shootings, violent threats, angry mobs, and generally vicious behavior have overshadowed civility and decorum.  Many decent people across the country feel overwhelmed and demoralized.  I don’t think anyone needs more stress, certainly not at the Thanksgiving table.

But all is not lost.  Difficult situations bring out the worst in some people but the very best in many others.  Heroic acts of courage and compassion abound whenever disaster strikes.  Few of us will ever have to save someone from a raging flood or fire, but we can all be a bit more thoughtful and understanding.  This year, consider a few ideas that might make Thanksgiving less stressful and more pleasant for everyone:

  • Don’t put pressure on loved ones to travel. People only have so much time, energy, and money to spare.  Controlling relatives is not helpful here.
  • Include someone who might otherwise be alone.  Chances are good such folks are all around you.
  • Don’t be a perfectionist in the kitchen. Thanksgiving is not a competitive event.
  • Offer to help or bring a dish, but don’t force your brussels sprouts casserole on the host. Some people don’t know when to cease and desist.
  • Resist the temptation to talk politics. Now is not the time to upset people.
  • Put a ban on phones, television, and assorted other devices. Through your church, synagogue, or club, sponsor a Thanksgiving dinner for a family in need.
  • Show interest in other people at dinner. Good conversation starts with sincere questions about the other person and really listening to that person.
  • Don’t inflict yourself on others if you’re sick. Someone will almost certainly be happy to bring you some wonderful leftovers.
  • Be genuinely grateful for all the blessings you do have. Let people know that you appreciate them.

Thanksgiving is a lovely holiday with charming traditions.  With a little extra thoughtfulness, we can make it better than ever for everyone.

The Holidays: A Time for Comfort Food

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

By Dr. Laura Pawlak

The term comfort food can be traced back to 1966, when the Palm Beach Post used the term in a story:  “Adults, when under severe emotional stress, turn to what could be called ‘comfort foods.’  These foods are associated with the security of childhood, the relief of stress, and euphoric feelings.”

Although the identification of particular items as comfort foods may be unique to an individual, patterns are detectable.  In a study of American food choices, males preferred warm, hearty, meal-related comfort foods, such as steak, casseroles, and soup.   Females consumed snacks as comfort foods, such as chocolate chip cookies and ice cream. Young or middle-age people, under 55 years of age, overwhelmingly chose snack-related, comfort foods.

As the holidays approach, families and friends gather to share an array of comfort foods that provide nostalgic or cultural value.  These foods are often characterized by their high caloric nature, rich in (1) carbohydrate and fat or (2) fat and salt.

Consuming energy-dense food awakens a group of brain structures wired together into a reward system.  This brain circuitry elicits emotions based on the sensory experience of the food.  Comfort foods trigger pleasurable feelings — moments of joy.

The chemicals responsible for feeling good are two-fold:  endorphins, nature’s opioids; and endocannabinoids, the feel-good chemicals found in marijuana.  Sugary foods activate the release of endorphins.  Pizza, cheese casseroles, and other fatty foods spur the production of endocannabinoids.

When fat and sugar are combined, as in desserts, an explosion of both endorphins and endocannabinoids floods the brain, causing elation beyond nature’s offerings.  The temptation to overeat may be overwhelming, especially when a fond memory is linked to the food.

Enjoying holiday celebrations, without consuming excessive amounts of comfort foods, requires forethought.  A plan is helpful!  For example, set aside the day before the event as a time to eat fewer calories.  Drink water, coffee, and/or tea. Have two light meals — perhaps a fruit salad and a green salad.

On the day of the celebration, eat a healthy breakfast and add a salad if you feel hungry before attending the festivity.  At the party, take a deep breath between bites of your favorite foods.  Notice the positive memories that surface as you eat slowly.

Lastly, don’t take goodies home.  Holiday gatherings are meaningful times with friends, not just food.  Savor the season!


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.

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