A Circle of Prayer

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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.

The Wise Whisper of Prudence

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By Mary O’Brien, M.D

They had second thoughts about it.  Twelve boys and their soccer coach had heard heavy rains were coming, but they went on their excursion anyway.  Tourists looking forward to an outing on a lake in Missouri never imagined how dangerous a storm could be.  The duckboat operators chose to ignore a forecast for thunderstorms.  They thought it would be alright.  Life jackets were considered unnecessary.  After all, they’re such a nuisance.  Two groups of people failed to heed the quiet whisper of prudence.  The first group survived, but only with the immense efforts of over a thousand people and the loss of a brave Thai diver.  The second group suffered catastrophic consequences with 17 deaths including nine members of one family and seven seriously injured.

Prudence would have prevented both disasters.  It’s not a word we hear much today.  In fact, it almost seems arcane.  Prudence sounds like the name of a fussy old maid in an eighteenth century novel.  The New Oxford Dictionary defines prudence as “acting with or showing care and thought for the future.”  Its origins can be traced to the Old French and Latin word “provident,” meaning “foreseeing or attending to.”  Could any reasonable person doubt the need for more prudence at every level of society?  Foreseeing or attending to the future is a tremendously useful virtue.

Many of us have fallen into the trap of wanting too much and, naturally, we want it now.  A flight delayed or cancelled due to bad weather leaves nearly everyone frustrated and upset.  It’s better to cope with temporary disappointment and stay alive.

Every year, people die in cars swept away by raging flood waters.  Thousands die or sustain serious injuries in accidents related to severe storms, blizzards, hurricanes, and tornadoes.  Prudence would have dictated staying off the roads in the first place.  Numerous other situations confirm this vital lesson.  Swimmers, surfers, golfers, hikers, campers, skiers, mountain climbers, and others have ignored prudent warnings and suffered terrible consequences.

Prudence does not shout.  It announces its presence with a whisper.  The next time you feel an uneasy, nagging sense of caution about something, pay attention.  It may just be the wise whisper of prudence.

A Unifying Moment

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Thousands of people have had one goal for the past two weeks. Included were Navy Seals, professional divers, engineers, rescue specialists, medical personnel, and logistics experts from around the world. These individuals have focused on one objective: saving 12 young boys and their soccer coach from a flooded, underground cave in Thailand. The resulting real-life drama has surpassed any possible storyline in a work of fiction.

The young team set out on June 22, 2018, for soccer practice when torrential rain and flash-flooding stranded them. They were reported missing, but dangerous storms and difficult terrain hampered searches. As the days passed, hope of their survival faded. Undeterred, two British cave divers navigated a 2.5-mile cavernous tunnel one- half mile underground. They were astonished to look up and find the boys and their coach still alive. News of their miraculous find spread across the world.

Intensive planning for the daring and dangerous rescue began with offers of help from around the world. Experts from the United States, Great Britain, Australia, China, Japan, France, Denmark, and other countries converged on the scene with elaborate equipment and supplies. Communication lines, medical supplies, clean water, high-energy food supplements, and oxygen tanks were painstakingly positioned. Deep, murky, filthy water combined with passages only 15 inches in spots complicated efforts. A group of Buddhist monks kept a prayer vigil at the rescue site, and millions of people from around the world prayed for success.

Sadly, during a practice run to position oxygen tanks, a 38-year-old former Thai Navy Seal died when his own oxygen ran out. His heroic efforts were acknowledged with full military honors at his funeral. Heartbroken but determined to succeed, the rescuers pushed onward.

On Sunday, July 8, the threat of monsoon rains, dropping oxygen levels, and rising carbon dioxide levels in the cave forced a decision to proceed. The boys would have to learn how to swim and scuba dive “blind” in a matter of hours. The boys themselves decided who among them would go first. The painstaking rescue plan brought four boys out on day one. Every available oxygen tank along the 2.5-mile trek was used. After a 12-hour interval to replenish and restage oxygen tanks, four more boys were guided to waiting medical teams. Another overnight effort to replenish and restage supplies unfolded.

Finally, on July 10, news that the remaining four boys and their coach had been rescued spread around the globe in minutes. It was a unifying moment of joy and relief for the world. The courage and composure of everyone involved was a testament to the human spirit. When people cooperate for the good of others, personal, political, and cultural differences melt away in pursuit of a noble endeavor. Bravo!

Pearls of Wisdom

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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.

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More Healthy Bread, Maybe Not!

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

By Dr. Laura Pawlak (PhD)

The vast variety of breads available in supermarkets and bakeries reflects the unquenchable appetite of Americans for this grain-based food.  Breads labeled as “whole grain” appear to be a smart way to add fiber to your diet.

Whole grains improve regularity, slow digestion, reduce appetite, improve cholesterol, and prevent spikes in blood sugar — a major driver of obesity, high blood pressure, and Type 2 diabetes.

A whole grain bread uses the entire grain seed:  the bran (an outer layer with fiber, antioxidants, and B-vitamins); the endosperm (the middle layer of starchy carbohydrates); and the germ (the inner core, which has vitamins, minerals, some protein, and a drop of oil).

Commercial whole grain breads differ in the relative amount of whole grain content in the product.  A simple calculation, called the “10 to 1 Rule,” can guide you in choosing healthy whole grain breads:  Using the nutrition facts on the label, identify the grams of total carbohydrate and fiber.  Divide the total grams of carbs by 10.  Is there at least that much fiber stated on the label?  If so, it is considered a healthy bread.

But wait, there’s something more to consider before purchasing a whole grain bread.  Andrew Weil, M.D., an expert in Integrative Medicine, states:  “A true whole grain food retains all three parts of the seed intact.  A recent government study linked the fiber found specifically in intact whole grains to a longer, healthy life, that is, a lower risk of death at any age from conditions such as cardiovascular, respiratory and infectious diseases and possibly some cancers.”

To make bread, the intact whole grain is ground into flour.  Some of the physical properties that promote good health are less effective when whole grain seeds are processed into flour.

There are many tasty, intact whole grains available, including: amaranth; barley; brown rice; buckwheat; bulgur; cracked wheat; farro; kamut; kasha; millet; oats; quinoa; rye; wheat berries; and wild rice.  Use intact whole grains as side dishes or stuffing, in soups, stews, and salads — and as a hot, breakfast porridge.

Despite research reporting some differences in the positive effects of intact whole grains as compared to processed (ground) whole grain flour, here’s the most important message:  Aim for at least three servings of whole grains every day, including cooked, intact whole grains, whole grain cereals, and whole grain breads.  Enjoy!

Note to Self

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By Mary O’Brien, M.D.

Anthony Bourdain. Kate Spade. Robin Williams. They had what most people dream of having: massive success; fame; money; and a fabulous lifestyle. And yet, on the most profound and intimate level, they were utterly miserable. They couldn’t find a way to love themselves enough to keep living.

They are not alone. Millions of people, known only to a few folks around them, suffer the torment of suicidal thinking. We’ve known for decades that most suicide victims see some sort of health care professional shortly before they die. There is no shortage of studies, articles, committee meetings, and conferences on the subject. But somehow very little seems to change.

Two days ago I heard an “expert” on TV insist we should ask every patient about his or her personal life, marriage, relationships, family and financial problems, and work stress. I’ve been quite ill in recent years, and I’ve seen multiple physicians. No one has ever asked me about any of these matters. Perhaps, since I’m a physician, they feel too uncomfortable to ask. I suspect, however, that the larger issue is our obsession with time and money. Herd ‘em in, herd ‘em out, generate more revenue. A discussion about personal problems can become lengthy and emotionally charged. It’s difficult to get a tearful, distraught patient out of the office. In far too many cases, we’d really rather not know about it. Besides, when someone is crying, it’s tough to stay focused on your computer.

We live in an ever more detached, isolated, dissociated, overstimulated, and under-loved culture. All the “fans,” “likes,” and “followers” in the world cannot take the place of one sincere, sympathetic listener who actually cares.

Morals, Manners and Mindsets

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By Mary O’Brien, M.D.

Our culture appears to be in free fall.  Movie moguls assault young women.  Campus doctors exploit and molest patients.  Gymnastics coaches and doctors engage in appalling sexual crimes.  The abuse of women and children has occurred for millennia. However, as individuals and as a civilization, we’re supposed to be advancing.

The human person, the human body, must be treated with dignity and respect at all times, at every stage of life.  The notion that we can do whatever we want, whenever we want is wrong.  It always has been, it always will be.

Professional stature is non-existent without self-restraint and honor.  And those in leadership positions who merely look the other way bear just as much guilt as the perpetrators.  It’s shocking to realize how much disgraceful behavior is tolerated out of ineptitude, laziness, greed, or complacency.  Virtually every sector of our society is at fault here.  Until we reach a critical mass of people willing to challenge this horrid behavior, nothing will change.

In our professional realm, there are a few things we can do to restore respectfulness:

  • Call patients or clients by their proper names: , Mrs., Mr., Dr., Reverend, Judge, etc. are all appropriate until someone invites familiarity.  Using first names with a new patient is not “friendly” as we have been led to believe.  It merely signals a sloppy level of unearned familiarity and unprofessional demeanor.  A medical or dental office is not a nail salon.
  • Male professionals should not be alone in an examination room with a female patient. The “expense,” “inefficiency,” or “inconvenience” of having a nurse or assistant present is an unacceptable excuse for this breach of protocol.
  • Manners matter. “Old school” nurses and doctors were taught to ask the patient’s permission before we touched him or her.  “May I listen to your heart?”, “May I examine your abdomen?”  No doubt some youngsters in health care would roll their eyes at this.  But we should never make assumptions about touching anyone (apart from emergencies), and yet it happens routinely today.
  • It’s good to remind ourselves, our colleagues, and our students that decorum and propriety are not old-fashioned and unnecessary. On the contrary, they are critically important, and their absence is palpable.

Morals, manners, and mindsets do not exist in a vacuum.  When someone is disrespectful or unethical in one domain, that vice will eventually metastasize.  Regardless of our age, culture, or profession, we should always try to treat others the way we’d like to be treated.  It’s not corny.  It’s not outdated.  It’s our only path forward.

A Little Reminder

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

By Mary O’Brien. M.D.

Are you a terrorist?  Are you a drug dealer?  Perhaps a criminal of some other variety?  The fact that you are reading this makes any of those possibilities quite unlikely.  And yet, our culture now assumes the worst of nearly everyone.  In an airport, we’re all treated like potential terrorists.  Hand the clerk in a grocery store a hundred dollar bill and she checks it to see if it’s counterfeit.  Anyone needing pseudoephedrine to breathe normally is treated like as if she may be running a crystal meth lab in her garage.  That’s ridiculous.  I don’t have a crystal meth lab in my garage.  It’s in the attic.  These days, too many people can’t recognize humor, much less reality.

Needing to fly somewhere does not make someone a terrorist.  Wanting to pay cash for groceries does not make someone a counterfeiter.  Trying to breathe more easily does not make someone a meth dealer.  Hoping for some pain relief does not make someone an addict.  As a society, we are making some very misguided judgments.  I recall that seven years ago I sought help from another internist when a long list of autoimmune diseases began spiraling out of control.  The “medical assistant” asked me what my main complaint was.  When I explained I had increasingly severe pain in my hands and feet, she quipped, “We don’t do pain management.”  I had to restrain myself.  I was there for a diagnosis, not a prescription.

Pain is the single most common symptom of most malignancies, autoimmune diseases, vascular diseases, and serious infections.  Renal disease, neurological disorders, metabolic diseases, and any inflammatory process can cause agonizing pain.  And we haven’t even touched on trauma.  Most patients who complain of pain are totally genuine and honest.  Some people exaggerate, some are manipulative.  Some, but not most.

Today, we have many veterans suffering constant pain from multiple amputations and other terrible conditions.  In many cases, they cannot obtain a month’s supply of pain meds.  They are forced to endure preposterous “policies” and “protocols” created by sanctimonious idiots.

If we really understood as much as we think we do about pain, pathophysiology, or pharmacology, we would ensure that patients have the pain medications they need to function.  Opioid addiction and overdoses are devastating problems.  But forcing patients with documented causes of severe pain to suffer needlessly is simply wrong.  Everyone who has had a cocktail, a beer, or a glass of wine does not become an alcoholic.  Everyone who needs chronic opioid treatment does not become an “addict.”

The whole point of health care is to relieve pain and suffering.  Perhaps we all need a little reminder.

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