Gimzoo

Staying Sharp

Mental health is something most of us take for granted until we start to lose it. When I refer to mental in this instance, I am specifically referring to our ability to think, reason and remember. Just as we need our muscles to move our bodies, we rely on the brain to direct all of our activities. Our ability to do so profoundly affects our physical health. I have a patient who is 106 years old. She has experienced many years of good health but she is now blind and can hear very little. She mostly mumbles to herself and her mind is no longer functioning well. Though she has been healthy enough to reach such an advanced age most would agree that we would not want to be in such a condition. I have another patient in her nineties who stays active and continues to teach a dance class. Her mind is active and quick. One would even say, "sharp as a tack." If we are going to live a long life, we want to maximize our chances of staying "sharp." Though there are no guaranties that we will not experience dementia or other problems, let me share some ideas on how we can maintain our mental acuity.

First, keep your mind free from mind altering substances. Drugs such as alcohol and marijuana will dull our senses. One of the biggest brain depressants are sedative sleeping pills. One would think that getting a "good night sleep" will help you be more alert and less tired the next day. However, studies have consistently shown that patients given sleeping pills function more poorly. They perform less well while driving and doing tasks requiring concentration. Antidepressants need to be used with caution as well. Although depression itself can cause symptoms identical to dementia, the medications used to treat it can cause one to be less than sharp. It is appropriate once an initial response is achieved to then decrease the dose if maintenance is required.

Stimulants trade short term mental activation for longer term lethargy. Most who grab something with caffeine to "wake up" don't think of the longer term consequences. Habitual caffeine use can result in more persistent, longer term fatigue and "brain fog." Methamphetamine abuse is soaring. Anyone who has known an addict will not confuse their mental sharpness with that of a sharp instrument. I have the same concern for prescription stimulants used to treat ADD. When they are absolutely necessary, the lowest possible dose should be used for the shortest period of time. We really don't know the long term ramifications of regular use for more than just a few years.

One of the biggest determinants of brain health in later years is maintaining blood flow to the brain. Just as decreased blood flow to the heart or the kidneys can cause disease, the same is true for the brain. This goes right back to our physical health. You want to be exercising, eating right and maintaining normal blood pressure and cholesterol values. This has been discussed in more detail in my previous posts.

Just as regular exercise keeps our muscles strong and active, regular brain activity keeps the brain connections working as well. It has been shown that those who do so have a seven fold decreased risk of developing Alzheimer's. This beneficial effect is for greater than any medication or supplement. Too many of us let others do our thinking for us. We spend too much time in front of television screens and not enough time reading, writing, speaking a foreign language, playing a musical instrument or doing puzzles and games.

Someone with a sharp, active brain is more likely to take an active interest in their health. They will study and learn about any conditions they have and may actually read this blog! Let us all do what we can to hone our brain. Let's keep our brains clear, let's stay active, let's stay sharp.

The Indomitable Human Spirit

One of the aspects that I love about my job is reading about scientific advancements. The human body is a remarkable organism and the more we learn about it, the more amazed I am. Each new scientific advancement is like peeling away the layers of an onion. That said, there are times when I cannot explain by scientific means what I observe with my own eyes. This often occurs at the end of life. Time and time again I'll see a patient at the end of life in the hospital whose organs are failing and may not even be conscious any more. I know as a physician that death could come at any time but what happens more often than not is that as soon as the last family arrives from far away, the patient will then slip away peacefully. I am convinced that amid the millions of cells in the body resides the spirit of man that cannot be quantified or studied in the usual way. Some how, some way, the patient senses the presence of his loved one. The spirit then is free to leave this life and the body is left lifeless.

Though the details may vary, the belief in a higher power and of man's spiritual nature are pervasive through almost all cultures. Assuming that we indeed have a spirit and that there is a higher power, how does that affect our health? Researchers have even tried to study the effects of prayer on health. The results have been controversial. It is difficult to quantify the "dose" of prayer and faith and the effect it may have on an individual. A more consistent finding has been that church attending individuals are generally healthier than their counterparts. It is hard to know if this is due to increased spiritual power, to the beneficial effects of quiet meditation and prayer on stress, to healthier life styles or to a combination of all of the above.

I have my own beliefs, of course, and feel strongly that our spiritual lives most certainly affect our physical health. It is not something I actively ask my patients to pursue but I do ask about it. I certainly encourage patients to both reach out to others in their congregations when they are in need as well as avail themselves of such support themselves during times of illness. I may not ask someone to pray but I will inform someone that I will pray for them. I certainly pray myself that I may make good choices for my patients and do what is best for them. I have felt a quiet power in my life as I deal with the stress of having someone's health depend upon my ability to both diagnose and manage thier conditions correctly.

If you have inclinations to seek for spiritual enlightenment, I encourage you to pursue them. A strong spirit will lead to a strong body, as we strive to keep all things in balance.

Subduing the Stress Monster

I realize this is easier said than done. I also realize that not all stress is the same. That said, let me share a few thoughts on how we can tame the beast other than resorting to the instructions on the right.

First off, don't neglect your physical health. when life gets busy and tensions rise one of the first thing to fall by the wayside is healthy eating and regular exercise. If there is no time to cook, be smart. You can rush into a grocery store and grab a prepared salad or fruit cup just as quickly as stopping by one of the fast food joints to get a burger. Make sure to grab some fruit. They can be eaten on the go at any time, with no preparation. Keep a water bottle with you at all times. Put one in your car or at work so that you are staying hydrated. At all costs stay away from the 'comfort foods.' It is not uncommon for the scale to go up commensurate with the stress level.

In regards to exercise, "make every step count" (see my previous post here). Exercise stimulates your muscle enzymes to metabolize carbohydrates more efficiently. It also causes the release of specific hormones in the brain called endorphins. These neurotransmitters effects a feeling of well being and satisfaction. It is not unlike the emotions from eating chocolate, only it is achieved by much healthier means. This effect has been studied in a scientific trial of patients with anxiety. They were divided into two groups. The first group was given a commonly prescribed medicine called an SSRI. The group improved pretty much as expected. The unexpected result occurred with the second group. This group was given no medication but they patients were enrolled in an exercise program. They also improved and their improvement was to the same extent as the medication group. I remember watching an interview on the news some years ago. A couple was celebrating their 70th wedding anniversary. When asked what his secret of success was, the husband answered, "to be married this long, you need to be alive a long time. I attribute my longevity to advise I received when I was married. 'If you ever get angry at your wife, don't fight. Get up and go for a walk.' I am an example of the beneficial results of regular exercise!"

The next point to keep in mind is to prioritize. Much of life's stress comes from the feeling that there are not enough hours in the day. It is overwhelming to feel that we are not living up to expectations, whether they be set by someone else or by ourselves. What is the big picture? Where do you want to be in 10 or 20 years? How do you want to live? Set intermediary goals that will help you achieve your
aspirations. Now, most importantly, make a list of all of the activities that make up your day. How do they help you achieve your goals? Now prioritize them according to their usefulness. When we are actively working towards set goals we will have the feeling of accomplishment, which is very rewarding. The worries from our stress will change to the contentment of our progress.

Now going from the big picture to the little one. There are times that we "sweat the little stuff." sometimes the smallest thing can set us off. Telling someone to be patient and to relax doesn't really help. How can we defuse our temper when it threatens to flare? One way is to anticipate stressful situations and plan in advance how we will react. We do much better when we are proactive rather than reactive. A great way to physically calm down is to force ourselves to breath more slowly. Try it: breath in through your nose and out through your mouth. The act of slowing down our respirations increases the effect of the vagus nerve counteracting the adrenaline response. This will slow down our heart rate, improve the oxygen delivery to our whole body, resulting in calming down our physical body. When that is under control, we can much more easily control our emotions as well.

This is by no means an exhaustive list but only a few of the weapons you can use to subdue the monster of stress that threatens to destroy your health.

Sabotaged by Stress

We all have stress in our lives. The source of it may differ, but we all have it. Even small babies show their stress when they are hungry, dirty or tired. We may not cry out and scream like they do, but admit it, you've thought about it! It isn't the stress that is the problem, it is how we deal with it. If it weren't for stress we wouldn't get much accomplished. Stress motivates us to work hard and be better. The key is to manage it so that it works in our favor, not to our detriment. When simple stress and worry turn to anxiety and panic, it will start to have adverse effects on our health. It can and does effect nearly every organ system in the body. Let me show you how.

Brain/Head:

Stress commonly causes mental fatigue. Our brain may feel overloaded and burdened. As such it is harder to hold onto facts that were recently learned such as names, numbers, tasks, appointments, etc. It also makes learning more difficult. Headaches are an extremely common result of stress. Migraines are common. Tension headaches also occur. Stress can lower the effectiveness of our immune system resulting in frequent sinus infections. Many people exhibit poor eating habits while under stress. Quick foods including candy and sweets are over consumed. This could result in poor dental hygiene and result in cavities and other mouth disease.

Lungs/Heart:

Shortness of breath is very common in panic disorder. To the extremes, hyperventilation can cause dizziness as well as numbness and tingling in the hands and feet. Chest pain is commonly a result of stress. It may be due to excessive adrenaline (a stress hormone) or just tightness in the muscles of the chest wall. The pain itself becomes a source of worry, which tends to trigger a cycle or worsened pain and more anxiety. Emergency Rooms are full of patients with chest pain due to this cause. Palpitations or skipped beats are a natural result of these stress hormones racing through the body. Blood pressure may be elevated transiently at times which can trigger actual heart problems. There are even extreme cases where the coronary arteries (blood vessels of the heart) will spasm and close off as a result of a sudden, extreme stressful event.

Digestive Tract:

The functional disorders of the gastrointestinal (GI) tract are all related to stress. These include irritable bowel syndrome, functional dyspepsia and cyclical vomiting syndrome. There are as many nerves in the GI tract as there are in the brain. It takes a tremendous amount of coordination to take what we eat and move it through the whole system. When our brains are under stress, those nerve connections often don't fire correctly. This can result in problems with swallowing, bloating, gas, cramping, constipation, diarrhea and or pain.

Endocrine (hormone) System:

Most diabetics can attest that during stressful times, control of their blood sugar becomes more difficult. This is due to the adverse effects of adrenaline, causing more cortisone to be released into the system,resulting in insulin resistance. It is commonly understood that stress affects female hormones. This can cause alterations in menstrual cycles and even increases problems of infertility.

Skin:

Those who are predisposed to eczema or have psoriasis can attest that stress can make either condition worse. I have seen patients with severe anxiety who constantly pick at themselves. They can develop small sores all across their body.

Muscles:

Of course, one of the first responses to stress is to tighten our muscles. In addition to the headaches and chest pains listed above, it can result in tightness in the jaw muscles (TMJ disorder) and especially tightness in the neck, back and shoulders. This is especially true for those who spend too little time moving and too much time in front of key boards and monitors. I guess that may apply to both you and me!

Have you experienced any of the conditions listed above? In some form or another I suppose we all have. In the next post I will discuss ways in which we can manage this stress which likes to sabotage our health.

Fitness and Finances

Our physical health is impacted by all the aspects of our lives. One of the most important is how we handle stress. Worry about finances is one of the leading causes of stress. The peace of mind that comes from living within one's means is usually more a factor of how we spend rather than on how much we earn. I have met many people who earn a substantial amount of money and yet still find themselves living above their means.

In recent years we have seen first hand what happens when individuals and nations spend more than they earn. My son recently told me, "Dad, I'm richer than the U.S. Government." I thought "how absurd," but then realized that he was absolutely right. Meager as his savings are, he has not accumulated any debt.

During the great depression, a religious leader taught, "Once in debt, interest is your companion every minute of the day and night; you cannot shun it or slip away from it; you cannot dismiss it; it yields neither to entreaties, demands, or orders; and whenever you get in its way or cross its course or fail to meet its demands, it crushes you." (J. Reuben Clark Jr.).

Now, I am not an expert in financial matters, but having navigated through medical school, I am well aware of the burden of debt. Once I finished my training, my wife and I focused on paying down our loans instead of accumulating material goods. It remains one of the best decisions we have made. We need to make interest work for us, not against us. It has been said, those who understand interest collect it, those who don't, pay it.

If you find yourself overwhelmed by debt, what is to be done? First, every expense needs to be evaluated. If it is not essential, it should be eliminated. There is no relief until debt has been conquered. A patient of mine recently told me of volunteering at a local food bank and seeing some people arrive to pick up food in expensive luxury cars, using smart phones. The car needs to be sold, the phone contract needs to be cancelled. Write down every expense and track it. This is just like what I ask my patients to do with their calories. In fact, we spend an awful lot of money on food. Make sure that you bag your lunch. Eating out is a huge expense and can be avoided. Drink water (see my previous post, "Drink Up"). The amount of money spent on soda, coffee, tea and alcohol is staggering.

Another way to cut expenses is through managing your medications. Many of them are very expensive. Sometimes there are alternatives that your insurance plan would cover or that may be generic, which can result in big cost savings. I know for a fact that your doctor cannot keep track of which medication will be the most cost effective for you. Look up all of your medications. If your plan lists cheaper alternatives, write them down and bring the list in to your physician. At times, there may not be a good alternative and you won't be able to switch due to medical reasons, but I for one, am more than willing to find cheaper alternatives for my patients if it provides the same benefit. The best way to keep down medication costs is to stay fit and in shape. Many of my patients would not need all the medications to treat high blood pressure, cholesterol, diabetes, acid reflux, arthritis and even depression if they could get their weight down through diet and exercise. Our physical health affects our financial health and our financial health certainly impacts our physical health as well. It is time to be fit.

Walking on The High Wire

Have you ever seen the person at the circus that walks on the tightrope? The amazing ones can even ride a bike across while balancing balls, plates, boxes and other items. It requires inner strength and great balance. Similarly, our physical health can only be maximized if we are in balance in all the areas of our life. If one area is neglected, it will affect the others. I believe that we must be aware and nurture our health not only physically, but also, mentally, emotionally, financially and spiritually. Let me touch on each of these, going in to more depth in future posts.

Mental Health:
We think of our youth as the years of our education but that is when it begins, not when it ends. Keeping our brain active is important to maintain alertness, awareness and to ward off problems with our memory. As our population ages we are seeing more and more of our family and friends develop dementia. The scientific community has looked at all sorts of drugs and even herbal remedies to aid the brain. None have been shown to be very significant. However, one study in particular caught my eye. Those patients who exercised their brain (puzzles, games, speaking a foreign language, playing a musical instrument) had a seven fold decreased risk of developing Alzheimer's Dementia than those who did not. In addition, those who are stimulated to learn and grow mentally are more apt to read this blog and other sources of health. Information is power. In regards to your health, it is the power to make healthy choices and meaningful changes.

Emotional Health:
Our emotional state has a huge bearing on our physical health. The stress from strained relationships can produce anxiety which is not just mental, but biochemical. When we are under stress, signals from our brain are sent to the adrenal gland which is stimulated to produce epinephrine (adrenaline). This courses through the blood stream, causing all sorts of effects. Most noticeably are those of the heart, making it speed up, contract harder and even causing skipped beats or extra beats. We can feel sweaty, dizzy and lightheaded. It takes up so much energy, that it leaves us tired and exhausted. Our immune system is taxed and we are left more vulnerable to colds and infections. Often, patients will come in and tell me all of their physical symptoms and complaints but no one wants to admit that it could be caused by emotional stress. It is much easier to be given a pill than to be told to work on improving relationships. I recently saw a woman who has had many complaints over the last year. She is currently doing relatively well and we have developed a strong enough relationship and understanding that I felt that I needed to discuss her family stresses in more detail. I told her, "I fear that the stress of your relationship with your husband is having adverse consequences on your health." Tearfully, she acknowledged that she felt trapped in the relationship and didn't even like going home after work. We talked of ways to get help for them both, and though I certainly didn't solve any of her problems, she left with an understanding of how that stress was affecting her health and is now better able to focus her energies on the cause rather than on the symptoms.

Financial Health:
Living within our means provides a peace of mind that is priceless. If we stay out of debt, we will not have to wonder if we need to choose to pay the mortgage or for a prescription. Financial worries can be all consuming and cause the same stresses and health consequences as outlined in the preceding paragraph. I realize that we all have different circumstances and some are left to struggle financially due to no fault of their own. However, most of us can manage our resources better than we currently do. We don't often think of how that impacts our health, but it most certainly does. From a more global perspective, it has been shown that the best way to improve the health of a nation is not to pour more money into health care but to work on eliminating poverty. We are much more able to take care of our physical health when we don't have to spend all of our energy on providing the very basic necessities of life. Getting as much education as possible opens the doors of opportunity and ties in to our mental health as stated above. Better jobs often have better health care benefits as well.

Spiritual Health:
The belief in a higher power, though not universal, is certainly pervasive in our world. It brings hope to the depressed and provides an individual with a feeling of purpose in life. Religious texts, such as the Bible, are full of examples of the power of faith to heal and to be healed. When a loved one has passed away, those who have a strong religious connection often have stronger support groups and cope better. As a physician, I have found great strength in being able to acknowledge a patient's belief and to support them as they may struggle with a serious illness. I feel I can better help them cope with their disease by understanding their beliefs. There have been scientific studies showing the actual merit of prayer. In fact, I pray for my patient's doctor each and every day.

All of these areas are important and must be balanced to achieve optimal physical health. Each of us may have more work to do in one area than another. When you are on the high wire of health, remember to keep all your burdens balanced!

Good Rays or Bad?

One of the key elements to our health is maintaining balance. Just about anything, taken to an extreme can have bad consequences. It is important to utilize one of our greatest, but often neglected, God given gifts: common sense. No where is this better exemplified than in how we deal with sun exposure.

We have learned that excess sun causes skin cancer. In the form of melanoma, it can be a rapidly progressive, deadly disease. The medical community has gotten the word out. Stay out of the sun. Use sunscreen. Protect yourself. This is all true.

Now, shutting yourself inside all day and avoiding the sun's rays at any cost is not necessarily a good thing. When the sun is out we all feel a little better. Just as it awakens our plants and helps them to grow, it has been shown to decrease our propensity to depression and lift our moods.

There is one are of our health that the sun is essential to our metabolism. It has to do with calcium. Calcium keeps our bones strong. It triggers our muscles to contract. Without it, our heart could not pump. It is very tightly regulated in our blood stream. One of the ways in which this happens is through Vitamin D. There are several sources of vitamin D in our diet but the active form which helps us absorb calcium, is formed through an enzyme that requires sunlight through the skin. Without vitamin D our body does not function well. I am finding in my own practice of medicine many, many people who have low Vitamin D levels. When I was in medical school, I was taught to consider Vitamin D deficiency in mostly older patients with thin bones who never get outside. We now live in a society where we go all day long without being outside. Instead of walking or biking to work, we drive. We sit all day long in buildings whether at work or at school. When we arrive home, we rush to the computer to talk to our friends on facebook or write on our blogs! We need more sun.

Sun exposure is bad, you say. In excess, of course it is. Just 10-15 minutes of sun exposure, three days a week is sufficient to maintain adequate levels of vitamin D. Grab a hat, wear your sun screen but get outside and enjoy those rays. Remember, keep everything in balance.