Introducing our new co-author at Friend to Yourself

Finally!

I’ve been hoping, asking, looking, waving awkwardly in the hospital hallways, trying to find someone who would join me in this great blogging experience with you on self-care. And, finally.

Please join me in welcoming Dr. Helme Sivet! You will love getting to know her, and she will love, as I do, sharing space with you. Keep on.


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Helme Silvet, MD, MPH, FACC
Loma Linda University School of Medicine
Chief of Cardiology, Jerry L. Pettis VA Loma Linda Healthcare System

Hello!

 

My Blog Journey

Sana (or Dr Q) and I have known each other for two decades or so (and yes, we have lived that long). We have spent hours talking about what makes us excited to be physicians, what gets us up in the morning, and what makes us upset. Finally, we decided that it was time to share some of these thoughts together. Taking care of self is a principle that we both try to teach our patients, but also practice ourselves in order to be effective parts of our families, communities, and humanity. The goal of this blog is to attempt both from the, perhaps, somewhat unique perspective of biology, and medicine as the starting point to self-care.

My Professional Journey

My medical experience started in the “old country” behind the Iron Wall – I grew up in Estonia and graduated from medical school there. After the Soviet Union opened its borders, I made my way to the U.S. and finished an internal medicine residency at Loma Linda University and cardiology fellowship at Brigham and Women’s Hospital/Lown Cardiovascular Center. Starting in 2003, I have worked at the VA system as a cardiologist. Along the way, I also graduated with an MPH degree from Harvard School of Public Health. I am passionate about making people get better – this includes preventing, treating and managing heart disease as a cardiologist – but also helping my patients make sense of their life journey. One cannot treat and prevent disease without caring for the whole person.

My Life Journey

Between my two sisters and myself, we have lived in 5 different countries – this has made for interesting holidays! Seeing different parts of the world up close has given me plenty of experience, but has also come with a certain sense of displacement. It has been a continuous struggle in my life to figure out where I fit in the wide world in general, and in my little microcosm of a world in particular. In this context, it has been fascinating to learn different things from different cultures, and observe how people with different life experiences can effectively communicate with each other. And I noticed that somewhere along the way, my quest for truth and knowledge is giving way to a quest of understanding and compassion.

Disclaimer

The thoughts on this blog are my own and do not represent entities I belong to in a professional capacity. The stories that I tell are true in principle but the details may have been changed to protect people’s privacy. The blog is not meant to offer professional advice or treatment advice for specific medical conditions; the goal is to share ideas, general principles and stories of a personal journey.

 

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

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

Who Am I? The Threat Of Exploring!

“Talking about me, I sometimes feel like it is scary to know more about me. I’ve found out who I am through very difficult situations so I have an association.”

My hunch is Ericka had many times when information and experiences came to her in her life on gentler carriers than those with this kind of emotional trauma. But she didn’t notice. The coming of kindly delivered insights are easily absorbed and drop from consciousness.

“I feel I overlook those and pay more attention to the bad things.”

It’s like gratitude, a muscle that grows when deliberately developed. That is why we call it the exercise of gratitude. When we deliberately practice noticing, (flex,) recognizing, (now we apply a little fragrant oil to the lovely bulge,) one more rep, (Oh yes! Look out Venice beach!) practicing gratitude, indeed, increases self insight. 

Ericka and I had this discussion in context of discussing her career. The starting point of exploring career choices brought us to look at the different paradigms that may be used to understand our identity, as well as it’s strengths and weaknesses. Poor Ericka felt that using the paradigm of “Personality Typologies” to be like inviting a bully into her living room. One that confined her, boxed her, took away her windows and doors.  However the paradigm of personality typologies is just a paradigm, useful or not, with the power or lack of power that we allow it. It is not a concrete cell, that defines us. It is one more way of increasing self insight, among others.

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“Footsie” by Carl D’Agostino, at, “I know I Made You Smile.”

How to Approach the Myers-Briggs:

Take Three times. Each time, read the descriptors to hone accuracy. (It’s a biased test. Taking it multiple times, as well as reading the descriptions helps eliminate the bias.)

The fourth time, the test is to be taken by someone who knows you the best in the world, answering the questions as if they were answering in your stead, with you standing by. Then read descriptors together.

This approach helps diminish the inherent test-bias in the Myers-Briggs personality test.

Example of free online test, (there are several,  http://www.humanmetrics.com/cgi-win/jtypes2.asp

We don’t have have to give it more power than you are comfortable with

2. Read, Please Understand Me, vol II

-Keirsy

3. Go have fun and…

Keep on!