Desperation – When to Speak

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I’m about to park in LA for the LAX protest against the immigration ban.

Last night my husband and I debated whether to come or not and were both disappointed to realize that we both wanted to be here. I mean, it’s Sunday and we don’t get a lot of down space. We have our kids who, thank goodness, still want more time with us. We have projects and exercise and self care that is on our agenda. We are moving away from a “zero percent progress” every day toward something better, right?

Apparently, I’m a moderate. I haven’t felt the pain. I don’t have the fire. But not very long ago was the Jim Crow era, where our parents came from.  When there’s something I’m passionate about, I have to get my feet moving or I’ll miss it.

But this immigration ban is bad. This is just xenophobia and racism.  It is personal. I think of my Lebanese cousins who have been in the war and immigrated to our country with their hairy arms and scars. I think of Mom. I think of my in-laws who arrived in New York from the Philippines with $5.00 in their pocket.

What have immigrants done for America? Well. Look around. What have you done? This is who we are.


In a protest, community is strong. Unity is strong. Today, there was some prodemocracy stuff, but there was also a lot of anti-Trump-eting and name calling.

The protest felt a little like people were peaceful. They were upset. There was a lot of Trump-fest going on. But it wasn’t just that. There was a little anger with a little despair. Those guys were suffering, but it could lead somewhere.

When we start protesting a person, it becomes a zero-sum. We lose the opportunity. We didn’t waste all of the opportunity today. It was mostly a foreboding of what could happen.

When Martin Luther King marched at the Lincoln Memorial, it was very organized. They had basically shut down the city bus transport by not using them and choosing instead to walk seven miles to work, or set up car-pools, an early Uber system. They were unified in their despair. MLK had been put in jail many times for his fire. He was not moderate. When he spoke, he spoke about justice and equality, and didn’t give stage to McCarthyism. He mentioned him, but that was it. If Trump were president at the time, he would have gotten the same mention in his speeches and letters.

MLK said in his letter from Birmingham Jail, that moderates are just as evil because they are not going against what’s wrong. And that’s what’s wrong with all these things is because we are moderate.

So one of the reasons we go to these things is so that we don’t allow things to passively happen.

“Shallow understanding from people of goodwill is more frustrating than absolute misunderstanding from people of ill will. Lukewarm acceptance is much more bewildering than outright rejection.”

We have a general idea that this isn’t right. But we don’t have that despair. We are privileged. But we have a sense that this is wrong. So that’s why I move. To help me understand.

Maybe we, in this generation, have not suffered enough to stay focussed on the principles being violated here. We are America. We believe in humanity. We do not discriminate against another race. We do not believe our race is better than theirs.

The world is small. A refugee physically, manually by another human’s own hands, who is being pushed away back into the ocean from a Greek beach because the Greeks cannot feed their own countryman, affects all of us. Starvation changes one’s belief systems, I am told. These people are not moderate. They are being violated. I don’t want to be a part of who violates them. It doesn’t need to be said that I wouldn’t want to be them.

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Why do we march? To get our feet moving. We want to learn more. We march to help us understand.

 

Self Care Tip: Find your fire, take a stand.

Questions: What’s your story about immigration? How is this personal to you? Keep on

 

This is What America Can Give You

I told my patient today,

“You’re smart, you’re beautiful, you’re young, you’re healthy. This is what you have. Go and do it. Fight hard. You can only control yourself. Don’t wait for someone else to fight for you. This is what America can give you. The opportunity to fight hard for yourself.”

Keep on.

Electroconvulsive Therapy: Addressing the Stigma

http://www.medpagetoday.com/resource-center/Advances-in-Major-Depressive-Disorder/ECT/a/61938?eun=g8732591d0r&xid=nl_mpt_special_reports_2017-01-16

The Heroic Patient

imagesSorena wore a black knit scarf around a thick neck, folds between scarf and skin. She came in with reflective smooth skin and frozen brow.  After many botox injections, she increasingly found it difficult to change her expression.  People often accused her of not caring about difficult things they were disclosing, and she realized the issue was, she couldn’t move her forehead.

She had a lot of empathy and was frustrated that people didn’t understand this.

We pulled at this idea for some time, recognizing a tension unplugged for her with each injection, a relief she experienced at visceral level. She just felt like she had to get her injections, driven toward them, like a bee toward the hive.

At some level it takes courage to get through the day.  She sees the effect.  Despite the fact that she should take a break from Botox, she can’t stop and this feels frightening.  She’s freezing her face.  It’s a terrible thing to know she has to stop something she is driven to do. It’s really hard. She’s trying to get through each day.

I told Sorena, “What you do every day to deal with this is brave. It’s harder. You have so much strength. You are doing it. You are getting through.”


I’m considering starting a podcast, “The Heroic Patient.” What do you think?

I want to interview Sorena and others with heroic life journey’s for you to discovery, connect with, increase awareness of, and appreciate.

The idea is to interview a world-community patient who will tell their “story.” It enters through the physician’s office doorway and increases transparency.

Many in our world community do not have a great understanding of what a physician nor a patient do in this exchange. You may think, “Well, everyone is a patient so at some level they do.” But:

  • How many, do you think actually go into a physician’s office?
  • How many variety of physicians does any one patient see in a lifespan?
  • How many get to tell their story?
  • How many of us hear each other’s stories?
  • How many of us understand how a physician solicits the details of a story so someone is “heard?”

If a patient were to learn the ‘behind the scenes,’ thought processes, interview techniques and analysis of the physician, would that be helpful to the patient?  Would the doctor learn from this dynamic interplay, and would the interview process evolve and grow from this? How would this effect stigma of all variety? Who knows?

What do you think? Is there a need for the “Heroic Patient” Podcast? If so, what are your recommendations and opinions?

The idea is that we are designed for connection. It’s friendly, remember? 🙂

Keep on!

Self-care Tip: Get transparent to get connected! Be a friend to yourself.

Stay Awake! to sleep well

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(Whomever it is that originated this stinking hilarious picture and quote, thank you!)

The glass half empty view on sleep and age:

When you are a child, you don’t want to sleep. When you are a parent, you could if you would, and you want to, but there are the kids. When you are fortunate enough to grow old, you want to, don’t have kids, but can’t.

 

The National Sleep Foundation Recommends:

Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13) School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11) Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Younger adults (18-25): Sleep range is 7-9 hours (new age category) Adults (26-64): Sleep range did not change and remains 7-9 hours. Older adults (65+): Sleep range is 7-8 hours (new age category)

Should-a, could-a, would-a, right?

“The amount of sleep required by the average person is five minutes more.”

~Wilson Mizner

One thing that gets left out of most sleep books (um, did I include it in my book??) and sleep talks, is how to be awake. Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as Modafinil. Don’t confuse this with taking caffeine. Caffeine is metabolized way to fast to be helpful in this regard. There are others one may discuss with their treatment provider.

Self-care tip: Get awake, really awake, during the day to sleep well at night.

Questions:

What is your daytime energy like? Alertness, attention, and memory? Do you sleep well in relation to this?

Please tell your story. Keep on.

Bad Sleep is Not Sexy

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I tell my patients some rough version of this:

My agenda is that you get sleep.
My agenda is not that you take your sleep meds the way I prescribe them.
Just don’t take them at a higher dose than prescribed.

When prescribed medication, sometimes my patients tell me they think, from me or from other physicians, that they need to do it exactly as prescribed. And that may be true. With most. But there are some medications, which must be specifically described by one’s prescribing provider, that may be used in the way that the patient determines is most useful. The patient needs to look, to think, to speculate, to reflect. Adjust the medication dosages, and try again.

Going forward, before I tell you how you should sleep and what to take for it, think about how your sleep is.  What are the difficulties you have with sleep?
Falling asleep?
Staying asleep?
Early morning awakenings?
Is your sleep refreshing?

Renaldo, (“Please call me Ren”), can’t fall asleep. He lays there for hours, before he finally falls asleep in the early morning hours.

In Spanish we call the early morning hours “la madrugada”. I’ve always enjoyed that word.

It’s been happening on and off for Ren over the past year, but is worsening lately. He is now afraid to go to sleep. Afraid to looking into the dark night while in the company of his thoughts. He has a feeling of dread as his evening comes around. He finds himself avoiding going to bed.

When dealing with insomnia, first we look at these personal observations. They are called “symptoms,” when they are involved in a pathology, a medical illness.

Then we look at why. Why?

To answer this we consider what regulates sleep in our body and outside of our body. These pathologies we suffer come from what is in our body and as they intersect with what stressors come to them from outside of our body.

There are so many medical illnesses that produce insomnia.
Inversely, there are so many medical illnesses that come from poor sleep.
There are also many behaviors and outside-of-our-body stimuli that affect sleep.
Hmm.  Well it’s not either/or. It is likely a tangle of these roots that make this ugly plant grow.

Where to start?

We have covered sleep hygiene a couple times. Have we made the changes in our home and personal sleep culture to groom our sleep accordingly?

Say we have. We don’t read in bed. We don’t have a TV in our room. We don’t use the bedroom except for sleep and for sex. Hey! Sleeping well is sexy! Ahem….          ….We keep the lights low. We try to go to and out of bed around the same times every day. And so forth.

If these were not attended to, a disease process may develop. It is during sleep that our body heals. None of our body rhythms heal during the day. All the neurotransmitters, chemical messengers, hormones, all of these replenish and regulate into a healthy rhythm during sleep. Also, all of our memories consolidate during sleep. That dumbing in parenting syndrome, which I’ve respectfully labelled “DIPS”, may come more from the broken nights, than by the busy busy kids.

Okay. Say we are practicing good sleep hygiene, yet continue to have poor sleep.

There is a reciprocity between symptoms and disease etiologies. In other words, a broken sleep cycle may trigger certain genes to express themselves, and vua-la! Ren is suffering from an anxiety disorder.

Or, Ren’s anxiety genes become triggered for another reason, maybe simply his age, maybe he has low testosterone, maybe he has a thyroid disease, or he snores, and his circadian rhythm, (ie, sleep cycle,) disrupts. Vua-la! Ren is suffering from a sleep disorder.

It’s like the wheels of my mom-van. I bumped the curb the other day and pinched my tire. I disregarded it, …and the orange hazard like on my dashboard. Don’t judge me.

My steering seemed to wobble over the next hour. I pulled over and sure enough. A flat. I wisely (grimace) decided I could just drive it to the repair shop, rather than get a tow. By the time I got there, my wheel was bent and my van alignment was off. There’s a reciprocity to the wellbeing along with the demise of my van’s health.

In my book, Sleep Well, I cover some of these anxiety illnesses. I don’t cover affective illnesses such as depression, or hormone imbalances, or so many other physical pathologies that are involved in generating poor sleep. They are also reciprocally important to emotional health and a quality of life.

I told Ren,

So what do you think is going on with your sleep?…

Questions:
What are your sleep symptoms?
Do they come from a pathology?
Are they triggering other pathologies?

Self-Care Tip: Sleep Well. Be a friend to yourself.

Robin Williams’ Widow Recounts His Story

Robin Williams saw me through my developmental years. His prolific cinematic accomplishments, whit, depth of character, courage in living with and dealing with mental illness – all this configured him into my life story. Never even thought about him dying. Until he did.

Enjoy reading an excellent interview with his wife.

Here’s to Robin

http://m.neurology.org/content/87/13/1308.full