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.

A Different Tradition

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

By Mary O’Brien, M.D.

Has your home returned to a relative state of post-holiday normality?  I’m almost there.  The boxes and bags and bows and ribbons have been put away until next year.  The “thank you” notes are in the mail.  And my kitchen table has been restored to an acceptable state of neatness.

Many people will start to focus on new year’s resolutions now, knowing full well the resolutions are unlikely to last.  I have a different tradition at the end of December.  It goes back quite a few years.  In a reflective state of blissful solitude, I write down my own little “year in review.”  It takes some time, thought, and effort, but it’s an exercise that can generate some profound insights.

  • What were the best or most positive events of 2017 — personally, nationally, and globally?
  • What were the worst or most tragic events of 2017 — personally, nationally, and globally? How did I cope or respond?
  • What event or situation made me feel most grateful?
  • What was the most beautiful, unusual, or remarkable sight I saw in 2017? (Personally, it would be difficult to top the perfect, unobstructed view of the total solar eclipse I had from my own backyard in August 2017.)
  • What was the biggest mistake I made in 2017? This one can be tough and sobering.
  • What was the most important lesson I learned in 2017? It’s often related to the biggest mistake I made.
  • What experience or moment touched me the most deeply?
  • What was the most noble, courageous, or generous thing I did in the past year? Coming up short on this one is not a good sign.
  • And finally, what could I do in 2018 to become a better person — physically, mentally, emotionally, and spiritually?

The little, personal “year in review” may not be as fascinating as a list of the year’s top news stories, viral videos, or celebrities who have passed.  It will, however, become profoundly revealing to you 10 or 20 years from now.

Have a happy new year.

 

Something Feels Different

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

By Mary O’Brien, M.D.

Are we there yet? I wonder as I stare at my kitchen table covered with gift bags, wrapping paper, bows, ribbon, tape, and scissors. Every year, I tell myself I’ll cut back a bit next year. It never happens. The pressure starts with Christmas-in-July sales on shopping channels. I confess I find it difficult to resist. I love buying and wrapping presents for people. It truly makes me happy, especially when someone is genuinely surprised and delighted. It’s a constructive way to take the focus off myself.

This year however, something feels different. It’s been a tough year with historic, natural disasters. Devastating hurricanes, floods, tornadoes, earthquakes, wildfires, and blizzards have wreaked havoc on tens of millions of people. Mass shootings, riots, and appalling, vicious acts of violence have left most of us stunned and horrified. My heart breaks for all of those who have lost loved ones and homes. How I wish I could ease their anguish.

I cannot restore lost loved ones, homes, and treasured possessions for people in California, Texas, Florida, and Puerto Rico. I can write a few checks and say a few prayers. Those are good things to do, but they never seem to be enough.

Then it dawned on me. There are lots of people suffering all around us every day. They just don’t appear on the evening news. Here, in Myrtle Beach, South Carolina, there are nearly 2,500 homeless teenagers. That seems ironic in a town that’s largely focused on tourism and fun. I decided to give some money to my almost-adult niece and nephew. I gave them instructions to go buy clothes for homeless teenagers. I have no clue what teenagers would want or need, but my niece and nephew do, and they did well. Unloading their bags full of jackets, hoodies, sweaters, socks, underwear, scarves, and hats, they announced they “had a blast” doing it. Surprise! Thinking of other people can be fun.

My kitchen table is still a mess. But this year, I realize how blessed I am to have a kitchen, messy table and all.

 

Let It Go!

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

By Mary O’Brien, M.D.

Did you survive Thanksgiving without major family stress or tension? If the answer is “no,” you’re not alone. Holiday gatherings don’t always bring out the best in everyone. Some folks are already frazzled by travel nightmares. Those hosting the feast are tense and worn down by days of planning, preparation, and cooking. No one ever has quite enough room in her kitchen for all the food, much less the guests who congregate in the middle of the mess. There’s nearly always one culinary mishap and someone is sure to announce she has a life-threatening allergy to gravy.

But wait! We haven’t even begun to address deeply ingrained differences in political perspectives, religious beliefs, and good, old-fashioned feuds and grudges. Was all of this supposed to be fun? Fortunately or not, many of us will have another crack at family festivity soon as we try to celebrate Christmas or Hanukkah. I have a few time-tested thoughts that might help—at least a bit.

  • Psychologists tell us that it takes 21 days to replace a bad habit with a good one. That means we have just enough time to make a difference. Starting now, try not to criticize, condemn, or complain. It’s not easy, especially in this culture. However, it will make the next family gathering much easier to endure, if not actually enjoy.
  • Remember some basic neurophysiology. The human brain cannot hold onto diametrically opposed emotions simultaneously. We can’t feel love and hatred at the same time. We can’t feel empathy and anger in the same moment. And we can’t experience gratitude and resentment all at once. It may sound simplistic, but gratitude is often the best remedy for resentment, anger, anxiety, and sadness. Those of us who have food, water, shelter, clothes, electricity, a little money, and a few loved ones have more than hundreds of millions of people around the world. Smile and say “thank you” — a lot.
  • Forgive yourself and everyone else. I’ve watched relatives feud for decades. They make themselves and everyone else miserable. None of us is perfect. We’ve all said and done things that were misguided or thoughtless. However, refusing to forgive is like drinking poison. It makes no sense. Forgiveness represents the ultimate act of overcoming ego. Let it go. LET IT GO!

Please don’t make me sing that song from “Frozen.” I have relatives who would never forgive me.