A Circle of Prayer

Posted on 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.

To Whom Much Is Given

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By Mary O’Brien, M.D.

Something is seriously wrong.  The unemployment rate is around 3.9 percent.  The most recent GDP (Gross Domestic Product) figure shows a 4.1 percent gain.  These are tremendous numbers, and yet, millions of people who should be building lives of their own are still clinging to mommy.  They don’t want to grow up, pay their own way, develop a career, make a commitment to another person, begin a family or household of their own, or accept responsibility for anything.  This is not good.  Maturity begins with the acceptance of responsibility.

Unfortunately, many of my fellow baby boomers have indulged their children to the point of pathology.  Feverish efforts to create a perpetual soft landing for kids have only enabled endless dependency.

In World War II, millions of young men in their teens and twenties signed up to defend the country.  No one who had stormed the beaches of Normandy or fought at Guadalcanal came home to sponge off mommy and daddy.

Even the relatively spoiled people of my generation would have chosen to live in their Volkswagens after college rather than go home to live with mom and dad.  Living with your parents after college was considered the ultimate sign of personal failure.

There are of course, millions of millennials working hard to develop their careers and raise young children.  But far too many still think that eternal adolescence is “cute.”  Arrested social development and “infantilization” of adults is not cute.  It’s medically, psychologically, socially, and even spiritually abnormal.  Our culture has gone off the rails attempting to normalize behavior that is clearly dysfunctional and disturbed.

Work is essential for a man to feel good about himself.  A woman needs a sense of accomplishment too, but a woman can also define herself through relationships and caregiving.  Depriving a young man of the satisfaction and fulfillment that comes with physical labor, challenge, and struggle is not in his best interest.  All too often part of the problem is a mother who desperately wants to feel “needed.”  Parents may complain about an adult child who won’t leave the nest, but as long as mom and dad pay the bills, little darling has no motivation to get off the couch.

Sometimes real love is difficult and even disruptive.  The fundamental responsibility of any parent is to provide and protect the child when he or she is young.  The job is not complete, however, until a child has been taught the skills necessary to become a capable, honorable adult who gives more than he or she takes.

“To whom much is given, much will be required.” Some people think that sounds harsh.  Actually, it’s one of the secrets to a happy, fulfilling life.

A Wonderful Ritual

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It has started.  Across the country, kids from kindergarten to college are heading back to school.

I miss that back-to-school ritual.  Shopping for new clothes (even uniforms), textbooks, pens, folders, notebooks, and lunch boxes made me happy.  Spending a day with my mom and sister focused on a bright, new beginning.  It was a wonderful ritual.  We would always be excited to show our dad all the new treasures.  He would heartily approve of our purchases and remind us to use them to get good grades.

I could be wrong, but I get the feeling that much of that ritual and tradition is fading away.  Online shopping, frantic last-minute errands, and people doing “their own thing” seems to be replacing planned family outings.  Maintaining some structure, routine, and ritual is more and more challenging.

But the “whatever” approach to life is not very fulfilling.  Human beings, whether they are in a newborn nursery or a nursing home, do best when they have a healthy routine.  If you have school-age kids, it may help to consider a few time-tested principles.  Establishing these “rules” is a lot easier at the start of the school year than it is after a month or two of foundering and fiascos.

  • Preserve and protect bedtime — few factors influence performance at school (or work) more than sleep. And most kids need a lot more of it.  Unfortunately, when kids stay up until 10, 11, or 12 at night during the summer and then try to go sleep at 8:30 or 9, things don’t go well.  Begin to ease everyone into school-day bedtimes and wake-up schedules a week before school starts.  Only the strongest and wisest of parents will even attempt this.
  • Get everyone up early enough to have a decent breakfast and avoid morning rush and chaos. Some people never learn this principle, but most successful people get up long before they “have to.”
  • Teach kids to prepare as much as possible the night before — homework, projects, clothes, permission slips, etc. This is another principle of success in life and does wonders for easing stress and anxiety.
  • Limit TV and screen time, especially on school nights. Bullying and generalized nastiness abound on social media.  Kids will always complain about rules and boundaries, but deep down every child wants to feel safe, secure, and loved.  It helps if mom and dad set a good example here.
  • Create a home environment that’s conducive to calming down. Overstimulation and overextending are epidemic in our culture and disastrous for concentration or restorative sleep.
  • Establish and maintain a family dinner hour without devices. Kids must be taught how to have a conversation and actually be attentive to others.  There are 50-somethings out there who haven’t learned this.

People will always insist they don’t have time for lots of things.  But we all get 24 hours of time each day.  The question is, which activities will really make a difference down the road?  Establishing a healthy back-to-school routine can be the foundation for a happy, successful life.

Pearls of Wisdom

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

By Mary O’Brien, M.D.

He was a disciplined thinker, a real-life Mr. Spock, in a world where so many worship emotion.  Dr. Charles Krauthammer died on June 21, 2018, after a battle with cancer and 46 years of paralysis from a diving accident.  He finished medical school at Harvard and trained as a psychiatrist before turning to political journalism.  Early in his career he won a Pulitzer Prize.  The rest is history.

Dr. Krauthammer was an intellectual force of nature.  Facts, reality, logic, and truth served as his compass.  He had an unusually inquisitive mind and was open-minded enough to allow his thinking to evolve.  This stood in stark contrast to so many in the media who idolize notions and emotions.

Always patient and respectful in debate, Dr. Krauthammer was kind, thoughtful, gracious, and dignified.  But those qualities never suppressed a laser-like wit and genuine sense of fun.  He knew what there was to know about baseball and chess. People loved being around him because they always learned something and had a good laugh.  Being confined to a wheelchair did not prevent him from enjoying life.

Most people will remember Dr. Krauthammer for his political analysis and writing.  But as a physician who struggles with multiple illnesses, I have a slightly different focus.  Here are just a few pearls of wisdom I learned from his remarkable example:

  • Resist the temptation to feel sorry for yourself. Bitterness and victimhood will not solve anything.
  • Think about death every day. This is not morbid.  Charles Krauthammer was a wonderfully cheerful, funny man.  Confronting death allows one to appreciate life fully.
  • Keep your focus on others. We live in an age of malignant narcissism.  Krauthammer rarely talked about himself and kept his focus on the needs, problems, hopes, and dreams of other people.
  • Be courageous enough to say what you think but always be measured and civil. Hatred and nastiness abound today. There’s nothing constructive or healthy about it.  Civility, patience, gentleness, and humility will always be the mark of true wisdom.

Dr. Charles Krauthammer could have given up on everything at the bottom of that swimming pool when he was 22 years old.  He chose to fight back, and I’m one of millions who is grateful that he did.

homestudy

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.

Chocolate: A Smart Food

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

By Dr. Laura Pawlak

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

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

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

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

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

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

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

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

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

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


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renowned biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

Steady As She Goes

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

By Mary O’Brien, M.D.

Are you afraid to open your financial statements for March? Have the recent market gyrations triggered a sudden interest in Xanax? Nonstop news cycles and social media postings have spawned massive overreactions to every comment made by political or business leaders. Down drafts of 1,000 points can cause even the most seasoned investors to panic. Over the past two months I’ve had to curtail my exposure to the business networks. Watching the Dow Jones Industrial Average plunge 700 points at 2 P.M. can make me feel as if I’m about to go into ventricle fibrillation. I’d rather stay in normal sinus rhythm.

Sadly, that is not a joke. I have a vivid memory of sitting at a stoplight in Little Rock, Arkansas, on October 19, 1987. It was about 5:30 P.M., and I was headed home from my office. Over the car radio I heard, “The Dow Jones Industrials are down 517 points.” I distinctly remember thinking, “Oh, he’s reading that wrong! The DOW couldn’t possibly be down that much.” It was.

Shortly after I arrived home, my beeper went off. One of my favorite patients was in the emergency room (ER) with a massive myocardial infarction. George A. was a 76-year-old gentleman from Hope, Arkansas. He had grown up in poverty but had educated himself and built up several successful businesses. He was bright, witty, charming, dapper, and gracious. But on that day, George A. had lost over a million dollars, at least on paper. He was devastated.

I grabbed my bag and raced back to the hospital. We got George admitted to the cardiac care unit (CCU). His electrocardiogram (EKG) looked awful, and he looked worse. He was utterly convinced that one dreadful day on Wall Street had destroyed his future. Around 8 P.M., George become very ill (coded). We worked on him frantically for over an hour, but we couldn’t bring him back. There was no doubt in my mind that the thought of financial ruin had literally scared George to death. I felt numb.

Later that week, two of my colleagues committed suicide. They had also lost a fortune, at least on paper. Everyone was stunned and afraid that week. One year later, however, the market had recovered nearly all of its losses. Thirty years later I still mourn the loss of three good people. For all intents and purposes, they died from acute financial panic.

I am no financial genius. But forty years of investing have taught me a few lessons that may help someone else:

  • Don’t watch market moves minute to minute. Before long, you’ll need heavy sedation.
  • Don’t dump stocks when everyone is panicking. You’ll almost always miss out on the best part of the recovery phase.
  • Remember the wisdom of the ancient Greeks: Moderation in all things. Balance stocks, mutual funds, bonds, certificates of deposit (CD’s), cash, real estate, and precious metals based on your age, health, family needs, and risk tolerance.
  • Don’t give in to ignorance, laziness, fear, or greed. Sixty-six percent of millennials have nothing stashed away for retirement. Failure to invest is one of the greatest mistakes of all.
  • No matter what happens, avoid the temptation to overreact. You are infinitely more important than your financial statements.

Now take a deep breath and open the statements from March. Steady as she goes. You’ll be fine.

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.

One Devastating Flaw

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

By Mary O’Brien, M.D.

It happened again.  Seventeen precious lives were snuffed out by a vicious young man.  Before their bodies were laid to rest, “experts” began screaming at one another on TV.  However, finger-pointing, shouting matches, and emotional rants do not solve problems.  Thoughtful, well-informed, practical strategies solve problems.

Clearly what we have been doing to prevent school shootings has been inadequate.  The reasons are myriad.

  • Gun control laws are flawed.  I’ve long been baffled by the fact that there are more restrictions on me as a physician prescribing four ounces of cough syrup containing codeine than there are on a violent teen buying an assault rifle. Most reasonable people would probably agree:  This makes no sense.
  • Counseling is a fine endeavor.  We need more of it. But caring, prudent advice will not stop slaughter.  It’s impossible to reason with someone who is irrational.
  • School security needs attention.  In Israel, schools are locked at the final morning bell and teachers with military training carry hidden weapons. We now have hundreds of thousands of well-trained veterans who could help secure schools and do data mining of social-media sites to enhance intelligence analysis.  Why are we not enlisting their help?
  • Over the past 30 years, children have been exposed to tremendous levels of violence on TV, in movies, and perhaps most intensely, in video games.  Here there are no consequences to killing, apart from racking up points. Many kids who have been left to fend for themselves never have been taught to respect another person.

Additional resources providing better security, practical law enforcement, and sensible mental health care are needed almost everywhere.  But one devastating flaw remains.  Many people realized the shooter in Florida was dangerous.  The police had been called multiple times over the years.  He had beaten his mother and reportedly tormented and killed small animals.  His social media postings threatened murder.  Other students feared him and school authorities expelled him.  The FBI failed to follow-up on two credible reports.

Why do any of us fear getting involved in difficult situations?  It’s simple. We’re scared to death we might be sued.  We’re afraid of revenge or even the possibility of being called “mean.”

Many years ago, I had to confront a serious situation in a training program. Patient safety and professional standards were on the line.  I took action I deemed necessary and was clobbered with a lawsuit along with several other faculty.  It made our lives a living hell for nearly five years.  Other physicians and administrators simply looked the other way.  They suffered no retribution.  Some of us did what we believed was right.  Some chose to remain silent.

On February 14, 2018, many people did the right thing.  Some of them died trying to save others.  None of us is off the hook here.  Fear can have fatal consequences.  Courage is the antidote.

Memory Loss

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

By Michael Howard, Ph.D.

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

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

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