I read a wonderful article by David Brooks of the New York Times called “The Moral Bucket List”.   He spoke about what is really important in our lives. I saw him interviewed about the topic. He pointed out that as a result of our desire to make our children feel special there is a growing rate of the population who feel they are very important.   In 1950, twelve percent of high school seniors said they considered themselves very important.  In 2005, the response was eighty percent.

Social media compounds the problem. With Twitter, Facebook and YouTube, one can easily be the star of his or her own show and many have become just that. Along with this attitude comes a sense of entitlement.   A great example of this is the recent rant by Britt Henry, an ESPN reporter who felt that since she was on television and “so important” that she could berate a towing company clerk.

In medical practice we see similar behavior.  There are many thoughtful, grateful patients out there don’t get me wrong.  But, there are some who feel entitled to immediate attention when it is not warranted and who don’t seem to understand that many of us are treating huge numbers of people.  David Brooks has inspired me to come up with a moral bucket list for patients.

• Be understanding. Improved access to health care has caused an overload to the medical system.  The majority of doctors are trying very hard to fit everyone in.  It may take some time for them to return non-urgent phone calls.  Be patient. A little empathy goes a long way.

• Be humble. If you see your doctor outside the office and mention an ailment, do not expect him or her to remember the details of your conversation. If you would like a plan of action, call his or her office if you would like the problem evaluated.

• Be prepared. Know your medications and your dosages. It will save a lot of time. Do not expect your doctor to remember your list. Although there is a ist in the chart, it takes time to sift through the medical record and quite honestly, you should know what you are taking and how much.

• Be honest and direct. Come prepared for your visit. Most doctors can figure out what is wrong with you if you give them a good history. We are not mind readers.

• Be a steward of your own health and wellness. The majority of disease is due to poor lifestyle choices. You cannot expect your doctor to “fix” you. The only one who can help you is you. Your doctor can be your guide but you have to do the work.

Finding what is truly important in life is essential. Learning to handle life’s challenges with grace and humility is a start.  When it comes to health a similar approach is needed. Treat your body with respect and appreciation and extend that same behavior to those who care for you as well. If you can do that, the world will definitely be a better place for all of us.

At my house next to our front door there is a beautiful bush filled with Daphne flowers. It smells wonderful and makes me smile on my way in and out of the house. That got me thinking. Can flowers make us happy? I did a little research and found several studies that do indeed show that flowers can affect our mood in a positive way.

At Rutgers University a behavioral research study has found that flowers elicit a universal reaction that can help people feel happiness. Those who received flowers felt less depressed and anxious after receiving them, and the flowers led to more frequent contact with friends and family.

A study done at Harvard found that when people had freshly cut flowers around the house, they were less anxious. They were happier at work and also expressed more compassion and kindness towards others.

A study done at Texas A&M found that when both men and women were exposed to cut flowers at work, they both had an increase in ideas and solutions to office problems. Men generated more ideas than women, but women had more innovative and creative solutions to problems when flowers were nearby.

Flowers have certain meanings according to those who specialize in that sort of thing (Taken from The Language of Flowers by Vanessa Diffenbaugh). If you want to say something specific you might try these: Gerber daisies represent cheerfulness, baby’s breath reveal everlasting love, bird of paradise say magnificence, hyacinth communicate beauty, and jonquils represent desire.

It is spring and flowers are blooming everywhere. If you want to brighten your day or someone else’s bring in some flowers or visit your local flower shop. It will help you to be more productive, tell people how much you appreciate them and keep a smile on your face!

As a baby boomer, I have joined the ranks of many of my brethren and can say I am part of the “sandwich” generation. I have children who are young adults and still needing support so they can eventually become independent. I had a parent that needed my help to fly and leave his nest as well.

On June 19, 2008 I lost my father. I would say that he died, but he wouldn’t let us use that term. He preferred that we say he “transitioned”. My father was an amazing man. He lived life with integrity and purpose. He was 84 years old and his mind was as sharp as ever. He had renal failure and had been on dialysis. His body was getting weaker and weaker and he finally decided to stop the dialysis. This allowed him to “transition” on his own terms. Once again his strength and dignity prevailed.

Having now gone through the experience of losing a parent and being there for the transition, it has caused me to look at how we see and experience death in our culture. I realize that each person needs to be allowed (whenever possible) to die on his or her own terms. My father had expressed his wishes to my family and me well in advance and we were able to discuss them with him and understand what he wanted. He also put these wishes into a legal document known as a living will. In his, he put me in charge.

At the time, I didn’t realize how important that was. But, when the time came, I had to act. I felt like Shirley MacLaine in the movie “Terms of Endearment” when she was fighting for pain medications for her daughter who was dying. I had to scream for morphine for my father when his lungs started to fill up with fluid. Fortunately, after quite a bit of drama, he was able to get what he needed and I honored the promise that I made to him.

His transition was peaceful and I am happy that he got what he wanted. In the wake of all this is a massive amount of grief, which is a natural part of life. It happened several years ago, but the memory is still fresh. I share this story so that it will allow you to pause and think about whether you have a living will. Have you discussed the issues of death and dying with your loved ones? Although many of us live as if we will never die, that is one of those things that is inevitable for all of us.

Although death is never easy, knowing what my dad wanted and knowing that we were able to provide it both with the living will and details of his funeral that he planned ahead of time, made things better somehow. Death is a natural part of the cycle of life. It is okay to talk about it and to address it when it is staring you in the face. But, it is also important to say all the wonderful things you want to say and understand the wants and needs of others before an emergency situation develops.

Hug your children, your parents, your brothers and sisters and your friends. Tell them you love them as often as you can. That is what my father taught me. I am glad I was able to tell him that many times before his grand transition!

I see a lot of depression in my practice. My experience treating it has been similar to what is discussed in medical literature. In about 70% of patients there has been some improvement with antidepressants, but a full remission has occurred in only 40 to 50%. In the interest of boosting this disappointing remission rate, I have been searching for something that will either augment antidepressants or that could be used alone.

I have found a supplement considered to be medicinal food. It is safe, and it really does work. It is a vitamin that is a form of folic acid known as L-methylfolate.

Folic acid is an essential B vitamin. It is found in green leafy vegetables, eggs, cereals and fortified foods (to name a few). When you take in folate or folic acid in your diet it is absorbed by the small intestine where it is converted by an enzyme into L-methylfolate. This metabolite is used to make serotonin, norepinephrine and dopamine, which are all important for mood regulation.

Scientists have identified 40 mutations on the gene responsible for making the enzyme that converts folic acid into L-methylfolate. The most common genotype is known as C677T. If there is one mutation on this gene your ability to convert folic acid is reduced by 34%. If you have two mutations, it is reduced by 71%. Now you probably are seeing where I am going with this.

If you have a defective enzyme then you cannot convert folic acid to L-methylfolate properly and you will have lower serotonin, norepinephrine and dopamine levels. These gene mutations are extremely common. The treatment is simple. It is a prescription of L-methylfolate, a vitamin. If given in the proper amounts (7.5 to 15 mgs) it can improve mild depression relatively quickly. In a study of elderly depressed patients, the response rate at 6 weeks was 81%. Results are often seen in just two weeks.

A recent study of those with major depression found that adding L-methylfolate improved depression from 7% for those on an antidepressant alone to 18.5% with the addition of L-methylfolate over a period of 60 days.

It is well tolerated with no more side effects than placebo. It does not interact with other medications. In my experience, if an antidepressant has produced a positive response but the patient is still somewhat depressed L-methylfolate can help.

The results I have seen are impressive. When I treat those with MTHFR mutations (with or without mild depression) with L-methylfolate their mood improves and often they sleep better. Related problems such as irritable bowel will often get better as well.

If you are depressed and/or on medication for depression, I recommend you ask your doctor to see if you have the genetic abnormality that I mentioned. The blood test is called MTHFR. It just makes sense. If serotonin levels are genetically low then why not find a healthy way to boost them?

Heartbreak: What is it and How To Get Over It?

A dear friend of mine recently went through a breakup that has left him heartbroken.  The end of the relationship was amicable but has been painful nonetheless.  His experience has caused me to wonder a couple of things.

What is heartbreak and is it purely an emotional issue or is there more to it than that?

And

What is the best way to help someone get over it?

In Webster’s dictionary heartbreak is defined as crushing grief, anguish, or distress. It has been present since the dawn of humankind. We know because poets and writers have described it through the ages. It is something that the majority of us have experienced and some have been left scarred and scared as a result.  What exactly is going on when the heart is broken?

There is new research that has answered this question. Scientists have found that it can actually cause physical pain.  In their study they took 40 people in New York City who had felt intensely rejected.  Their brains were being scanned as they were instructed to look at a set of photos of friends and think positive thoughts.  Then they were given pictures of their exes and told to think about their breakups.  Lastly, they were given brain scans when they received an actual pain stimulus. The same part of the brain lit up when they were thinking of their exes and when they experienced physical pain.

There is an extreme version of this called Broken Heart Syndrome.  I have seen this a couple of times in my practice and it is dramatic.  It usually happens when there is either a traumatic loss or a breakup that comes out of the blue.  This type of pain actually looks and presents just like a heart attack.  The heart will not function normally when this occurs but there is no evidence of heart damage.

The shock of the event causes a huge outpouring of adrenaline, which acts like a stun gun to the heart.  This causes it to malfunction for a short period of time (usually no more than a week). These patients need to be observed and cared for in the hospital until things return to normal.

How can you help a friend to get over heartbreak?  To be honest, in the throws of a breakup it is really hard to tell anyone how to get over it.  However, there are a couple of things that might help.  The most important thing to point out is that if someone is heartbroken they actually have a heart.  They were able to become vulnerable and connect with someone on a deep level. They were able to love and allow themselves to be loved. Love is what makes life livable.  If they can do it once, they can do it again.

It is also important to note that they now have the knowledge of what works in a relationship and what doesn’t. This offers an excellent chance for introspection that can help them to find the person who can be a more compatible partner.  With this insight they will know what to look for in their next relationship.

Once someone is over the initial loss they may be more receptive to the rest of this advice.

• It is important to eat healthy and exercise. That will help you to feel better regardless of how sad you still might be.

• Keep busy.  See friends and do all the things you like to do. It could be going to a movie, dancing, or just having dinner out with friends.

• Give yourself time to recover.

• Be kind to yourself. It is over. Don’t look back. We all tend to obsess in the land of “would haves should haves could haves”. Don’t go there. Be present in the moment and then you will be able to move forward.

• Finally, laughing helps. Go to a funny movie, hang out with people that are positive and help you to see the humor in the world.

Time often does heal all wounds and sometimes we are left with scars.  But, hopefully it leads us to where we ultimately are meant to be.  As one who has had my heart broken many times, hang in there, you will get over it. It may not seem like it in the thick of it, but you will. In the meantime, take care of your health so that you can enjoy yourself when you get to that point!

I leave you with these words of wisdom.

“Perhaps that is what the stories meant when they called somebody heartsick. Your heart and your stomach and your whole insides felt empty and hollow and aching.”

Gabriel Garcia Marquez

AND Just one more thing…..

This is a quote from Elizabeth Gilbert’s book, Eat, Pray, Love from Richard who is telling her why she should not feel  so horrible about the end of her relationship with a man she identified as her soul-mate:  “A true soul mate is probably the most important person you’ll ever meet, because they tear down your walls and smack you awake. But to live with a soul mate forever? Nah. Too painful. Soul mates, they come into your life just to reveal another layer of yourself to you, and then leave.”

As I get older, I have to admit the subject of longevity is more interesting to me. I have been looking into what the secret to a long healthy life might be.  I am slightly surprised by what I have found but not disappointed.  There is as Curly stated in the movie City Slickers, one thing.  But, I am not giving the answer away just yet.

Of course, eating healthy and exercise is a big part of overall health. However, it is not necessarily the sure way to longevity.  The woman who has lived the longest life so far was Jeanne Calment.  She lived in France. She smoked from the age of 21 to 117. She ate 2 pounds of chocolate a week and rode a bicycle till she turned 100 and took up fencing at the age of 85. However, she was not a health nut.  She suffered many losses and changes in her life and throughout she kept her wit and her cool.  Ms. Calment was basically immune to stress.

Studies of the long living Okinawans in Japan have found several factors that explain their longevity. These include:

• Okinawans exercise physically and mentally
• Their diets are high in fruits, vegetables and fiber containing foods.
• They eat organic soy that is high in flavonoids.
• They do not overeat. They stop before they are full and consume a modest number of daily calories.
• They eat a diet rich in natural vitamins and antioxidants.
• The elderly are respected and appreciated and included as an important part of their society

The psychologist Lewis Terman started a study called the Longevity Project in 1921.  He and his successors followed 1500 children over the course of 80 years. They came to some interesting conclusions. They found that conscientious children and adults stay healthier and live longer.  The reason for this is that they are more likely to take care of themselves and adopt a healthy lifestyle.  They also seem to be less likely to develop diseases in general, and they form healthier relationships.

The Harvard Longevity study followed Harvard grads from 1940 till they died.  The study found that the secret to a long and happy life had to do with having close relationships and finding a path that is fulfilling. Those who participated in vigorous exercise on a regular basis also lived longer.

Thus far I have left out the one thing that all these studies found when it comes to the secret of a long and healthy life. It is true that healthy eating and exercise make a difference and that learning to cope with stress is important and that it helps to be conscientious, but the real secret is love. Whether it is the love of people or a passion (such as Beethoven and music), the true secret of longevity is simple. It is to love and be loved.

“Where there is love there is life.”  Mahatma Gandhi

I recently returned from an amazing trip to Bhutan; a small country tucked between Tibet and India.  Bhutan is known as the happiest country in Asia promoting “Gross National Happiness”. It is also known for spectacular monasteries and terrain.  One of its national treasures is the Tiger’s Nest.

It is said that the Guru Rinpoche (also known as the second Buddha) visited Bhutan in the 8^th century. Legend has it that he flew in on the back of a tigress and stayed on the side of a cliff to meditate for three months.  This place is known as Tiger’s Nest Monastery and is one of the most sacred religious sites in Bhutan.

To get there you need to hike up the cliff that quickly goes from 7000 to 10,000 feet. It was not easy.  Our guide said to take it slow and to stay in the moment.  He also suggested repeating the meditation words that the monks use in prayer. The words are: Om Mani Padme Hum.  I am in pretty good shape, but I noticed as I started going higher that I was breathing heavy and getting light headed.

So, I decided to give the meditation words a try. The harder it got, the faster I repeated them in my head.  Before I knew it, I was at the top.  I was amazed. I made it in one piece and it was beautiful and well worth the climb!

Meditation is something I have done most of my life.  I have tried Transcendental Meditation, Mindfulness meditation and Yoga meditation. This was the first time I had tried the Tibetan/Buddhist form of meditation.  They all work, if you actually do them. That of course is the key.

For me, meditation has become a twice-daily habit just like brushing my teeth. If for some reason, I forget, I feel off balance. I do it because it makes me feel better. There is a fair amount of scientific evidence that substantiates that feeling. Recent studies of meditators have found that they are able to preserve more brain matter and function as they age compared to non-meditators.  In addition: It is helpful with anxiety disorders, asthma, cancer, depression, heart disease, high blood pressure, pain and sleep problems.

To meditate, you focus your thoughts either by repeating a word, set of words, following your breath or listening to a guided meditation. If done correctly, it lowers your blood pressure and pulse and will evoke a relaxation response in the body.  It can be done anywhere or anytime. You can do it while you are walking or sitting quietly. There are tapes to help and phone apps.

There is no downside. If I can do it so can you. Meditation got me to the top of Tiger’s Nest. There is no telling where it will help you to go. Try it today!

As I said in an earlier post, I am perplexed as to why we are having the discussion regarding vaccinating our children in the US.  I received feedback from some who said their children were harmed by vaccines.  Exactly what that harm was, I do not know.  I acknowledge that there are risks to everything. However, using the vaccine risk that is small as justification to not treat our children is foolish. It reminds me of the occasional story of someone who is killed in a car accident because they were wearing a seat belt. Does that mean I stop wearing my seat belt, of course not. I know that sometimes things happen that are unexpected, but I have to go with the safety odds.

Just as I was trying to find a way of helping people to understand the importance of vaccines, I happened to hear an interview given by Bill and Melinda Gates.  They were talking about the mortality of children under 5 years old around the world and how it is dramatically changing for the better. Why?  Because of the global vaccination program.

Recent data from the World Health Organization shows that the vaccination rates are at their all-time highest.   Those getting the basic DPT vaccine jumped from 66 to 79%. The death rate from measles has fallen by 92% in Africa. If the vaccination rates continue to increase, 8 million children will be saved worldwide by 2020.

The protection from vaccines goes well beyond those who are 5 and younger.  As an example, hepatitis B is one of the major causes of chronic liver disease and liver cancer worldwide.  When I was an intern, I watched helplessly while a 29-year-old patient of mine died of fulminant hepatitis.  His liver disintegrated before my eyes.  I was so grateful when the vaccine for hepatitis B was released many years later.   I made sure my children got it as soon as it was available.

It is estimated that as many as a third of the world’s population has been infected with the hepatitis B virus.  About 5% become chronic carriers and 25% of carriers develop serious liver disease such as cirrhosis and liver cancer.  Hepatitis B infection is responsible for one million deaths a year worldwide. It will take time, but as the vaccine becomes more readily available this will change people’s lives and health for the better.

We are lucky in our country that vaccinations are widely accessible and affordable. Perhaps a worldwide perspective will help to understand why they are so important. Until these diseases are wiped out, with worldwide travel, we are all at risk for potentially deadly infections unless we are protected. Please vaccinate you and your babies. It will save your lives and the lives around you.

I have to admit, I am baffled. Why are we arguing about giving children vaccines? I do not understand why parents would not want to protect their children from diseases that could harm or even kill them.

There is no connection between vaccines and autism. Many, many studies have shown that.  Andrew Wakefield who initially made this claim published fraudulent study results on twelve children. Lawyers who were looking to win a case against a company that made vaccines paid him.   There is no credible evidence here.

Since he published his study, diseases that had almost completely disappeared have started to come back with a vengeance. The latest outbreaks have involved chicken pox and measles. Parents are reluctant to vaccinate their children based on a discredited study written by a doctor who was stripped of his license as a result.

I remember having chicken pox and mumps.  I remember how miserable my sister was when she had the measles, and I remember seeing some of my friends in leg braces after they developed polio.  Since the early 1960’s, vaccines made it possible to avoid getting many of these diseases.

Young adults these days have never seen or experienced these illnesses.  They don’t realize how devastating they can be.  Maybe that is part of the problem.  They also have a distrust of big pharma and the medical profession in general.

I live near the town of Ashland, Oregon where the vaccination rate is one of the lowest in the nation.  In my opinion, it is not a matter of if but when an epidemic will occur. The vaccine for measles is not given until a child is a year old.  It is not effective until then. What those who insist on avoiding vaccination don’t seem to get is that if they get sick they are putting infants and immune compromised children (who may not respond to the vaccines) at risk for diseases that could kill them.

Up until recently, those who were vaccinated offered a buffer to those who were not.  This is called herd immunity. That buffer is going away as a result of the ease of world travel and the increase in those who are unvaccinated.

This insistence that they know better and that by being healthy they will resist these highly contagious diseases is the ultimate in selfishness and ego. It pains me to think that it will only be illness and loss that will convince them of the need for prevention with vaccines.

I can only hope that those adults who were never vaccinated as well as parents who are choosing not to vaccinate their children will come to their senses.  Hopefully, this will happen sooner rather than later.

Despite the fact that there has been a huge campaign to inform women about the different ways that heart attack can present, we (women) are still waiting too long to call for help. I believe that one of the reasons has to do with our nature. Most of us live in the land of denial. We do not think that something like heart attack can happen to us. In addition we are so busy taking care of others that we often ignore our own symptoms.

Research looking at heart disease in women done by the National Institutes of Health found that 95% of women studied noted symptoms that were unusual for them one month prior to having their heart attack. The most common being unusual fatigue; sleep problems, shortness of breath, indigestion and anxiety.

Despite all the research and push for public awareness, heart disease is still the number one cause of death in men AND women. Risk factors include: family history of heart disease, high blood pressure, high cholesterol, obesity, diabetes, lack of exercise, smoking, stress, and low magnesium.

Regardless of whether you have any of these risk factors or not, if you are a woman and you experience overwhelming fatigue like you do with a bad flu, (but you don’t have the flu), trouble sleeping, anxiety, a sense of dread, shortness of breath, vague chest or jaw discomfort; you may be having a heart attack or you are about to experience one.

If that is the case, do NOT drive yourself to the emergency room. Do NOT wait till a friend or family member can take you to the emergency room. Do NOT ignore the symptoms. Do call 911 and chew an aspirin while you wait (provided you are not allergic to aspirin).

The reason you call 911 is that you want to be cared for as soon as possible. As most cardiologists will tell you, time is muscle. If you take yourself to the emergency room, you may have to wait and that might have tragic consequences. I had a patient many years ago, who had her heart attack while she waited three hours in the waiting room of a hospital emergency room. Do not let that happen to you. The longer you wait the greater the chance you will sustain long-lasting heart damage. The sooner they can help you the better your chances of a full recovery.

Most of us may be self-sacrificing but we have really good gut instincts. Listen to your intuition. If you think that something is wrong with your heart then you are probably right. Take care of your heart so it can take care of you and keep you vital and healthy.