Saturday, September 29, 2018

Do You Bend or Break?

Resilience: the capacity to recover quickly from difficulties, aka “toughness”, or the ability to “bounce back” from hard times and tribulations.

     Is resilience something ingrained in us from birth, or is it a characteristic built on a lifetime of hardship? Why can one individual overcome a life of heinous and unspeakable misfortunes and afflictions, yet others fall into a deep dark life of depression, addiction and self harm? It is unclear why some demonstrate an immense capacity for resilience and others crumble at the first sign of trouble, but there are certain characteristics that the most elastic over-comers share.

     Take into consideration the story of Immaculee Ilibagiza, an inspiration to anyone that has endured hardships which likely pale in comparison to what the young girl endured at the hands of evil. Immaculee endured some of the most atrocious misfortunes that are beyond comprehension and human imagination at the age of 24. As a Tutsi survivor of the Rwandan genocide of 1994, Immaculee lost her beloved mother, father, and two of her brothers to brutal murders at the hands of the Hutu enemies. She survived for 91 days with seven other Tutsi women locked in the three by four foot bathroom of a Hutu pastor who was a family friend. They were the lucky few, hidden from the savage slaughtering of over one million fellow Tutsis, often at the hands of prior friends, neighbors, and school mates that turned enemy due to socio-political differences. After enduring three months of starvation, silence, immobility, and the inability to shower, Immaculee and her peers were saved at the hands of French allies, however, were forced to witness hell on earth. Surrounded by stacks of dead men, women, and children raped, tortured, and chopped to pieces by Hutu machetes, the place Immaculee once called home was pummeled and destroyed, burnt to the ground, and scattered with the bodies of her loved ones and friends. At only 65 lbs, weak, and emotionally battered, Immaculee managed to learn English while locked in the pastor’s bathroom and developed faith beyond measure through prayer and optimism. Throughout her entire journey she relied on her strong faith in God and the power of prayer to carry her through. Not only did she forgive the man who murdered her mother and brother face-to-face, but she managed to acquire a job at the UN in Rwanda, eventually emigrating to the United States, marrying, and building a family of her own. She authored several books, earned five honorary doctoral degrees and now tours worldwide as a motivational speaker. The epitome of resilience, she is a testimony to the power of faith, prayer, and positivity in the midst of the most terrible tribulations. 

     As the ancient metaphor goes, “resilient people are like bamboo in a hurricane, they bend rather than break”. At the core is strength and a solid base. Just as the bamboo tree, a resilient individual such as Immaculee Ilibagiza has a strong foundation of faith that there is something larger than oneself. The realization that we as human beings do not have ultimate control, and we have to rely on a higher power for answers and strength despite our stubbornness to do things ourself. Resilient individuals see themselves as survivors rather than victims. Their cups are half full (optimism) rather than half empty (pessimism), and they have the desire to continue filling the cup in order to heal and overcome. Resilient people have a sense of purpose, and rather than allowing hardships to rip it away, they see them as an opportunity to fulfill their purpose even more. 

    Resilience is a staple of health and wellness, and although many likely have an innate characteristic that predisposes them to such strength, it is possible to build it with a support system and healthy lifestyle behaviors.

Stay tuned for part 2: Building Resilience

Read more about the story of Immaculee Ilibagiza here:

Monday, August 13, 2018

Depression - Are we Deficient in Anti-Depressants?

Depression has become a common ailment affecting millions of individuals both young and old all over the world. Per the National Institute of Mental Health, in 2015 over 6.7% of the United States population over the age of 18 had experienced at least one depressive episode in the previous year, and per the CDC, from 2011–2014, 12.7% of persons aged 12 and over had taken an antidepressant medication in the past month (August, 2017).

Unfortunately, many health care providers utilize medication therapy as the one and only modality of treating depression without addressing some of the most effective strategies for emotional health which can often be achieved with simple lifestyle modifications. Oftentimes medication therapy can worsen the situation, especially considering that many of them (such as selective serotonin reuptake inhibitors – SSRIs) can increase impulsivity, therefore increasing suicide risk. In addition, these medications can often cause unwanted symptoms such as weight gain, decreased libido, and sleep disturbance which create other health disparities for unsuspecting individuals.
  I am pretty sure there has never been a case of someone deficient in Zoloft, Effexor, or Paxil so why are we utilizing such medications as a band-aid for anyone that expresses symptoms of depression?  There is a simple fix that can be implemented prior to resulting to pharmaceutical intervention in the form of nutrition. There has been a barrage of studies that correlate the quality of diet as a contributor to mood stability and emotional expression. Both vitamin B-12 and folate play an active role in the process of neurotransmitter production, phospholipids that coat myelin sheaths, and cell receptors. There are several other nutrients that play a role in reducing depressive symptoms as well including selenium, vitamin D, omega-3 fatty acids, antioxidants, and zinc. A well-balanced plant-based diet can provide many of these vitamins and nutrients necessary for enhanced emotional health. For instance, dark leafy greens, whole grains, and legumes are a great source of folate. 
On the other hand, there are several foods and nutrients that can worsen depression, including refined sugars, alcohol, caffeine, and processed oils. Several studies have linked sugary food and beverage intake to common mental disorder and depression. A study conducted by Knuppel, Shipley, Llewellyn, and Brunner (2017), demonstrated a 23% increased risk of incident common mental disorder in men with the highest intake of sugary foods and beverages over the course of five years.
A simple plan of temperance and the implementation of a plant-based diet could provide benefits that may alone prevent and treat depression symptoms without resorting to pharmaceuticals that only compound negative health issues. 
"Let food be thy medicine and medicine be thy food"
  — Hippocrates, father of medicine, 431 B.C.

Saturday, March 31, 2018

Is There a Place for Spirituality in Medicine?

     Let us start with a definition of “spirituality”. When searching the “black hole” of the internet for the meaning of the world spirituality, many definitions can be uncovered. I have constructed my own definition based on the countless number of interpretations out there. In a nutshell, spirituality can be defined as a sense of connection to something bigger than ourselves, a concept of deeper meaning as a basis for how an individual lives his or her life. It is the quality of being concerned with the human spirit and it’s origin as opposed to outward, physical attributes and material things. For some, spirituality is expressed in partaking in organized religion, prayer, and in adhering to specific moral principles and values. For others, spirituality and religion hold two separate meanings and should not be intertwined. A large portion of modern society has become so self-absorbed and concerned with what will benefit them and them alone, that some definitions of spirituality have morphed into a concept of self-desire with the absence of any concern for truth, or belief in something bigger than themselves.
     With the knowledge that the art of medicine should be practiced with a solid foundation of concern for others, it is no surprise that the notion of “narcissistic spirituality” would be antagonistic rather than an integrative concept. On the other hand, I strongly believe that spirituality in terms of faith, comfort based on existence of a higher power, and purpose in life, has a vital role in medicine. This is not to say that we as health care providers should attempt to impose our spiritual/religious beliefs on others, but we should be open to those who desire this aspect of care and should offer to support them in terms of their spiritual needs. We do not need to know what religious group someone belongs to, or what spiritual beliefs he or she holds. It is not our place to judge anyone based on the details of their spirituality; rather we should seek to care for our patients in a holistic manner, caring for mind, body, and spirit, based on their individual needs and concerns. This means listening carefully, acknowledging any spiritual concerns, providing comfort and support, and if desired, offering to pray with them.

     As a provider with a sincere concern for the health and well-being of my patients, I see the importance of addressing needs beyond the physical realm. Not only is there a barrage of research data out there documenting the benefits of spiritual care in medicine; however, I have witnessed the benefits countless times in interacting with my own patients. Meeting spiritual as well as physical needs provides a level of care that is unparalleled. Evidence (and common sense!) demonstrates that religion/spirituality coincides with optimism, well-being, happiness, and hope to name a few of the associated positive emotions. These emotions, in turn, enhance immunity, healing, and positive mental health outcomes. It has been demonstrated that chronic stress and despair can cause a significant decline in the immune system, specifically the antiviral and antitumor responses. Cortisol and epinephrine are the stress hormones responsible for this decline, and without happiness or hope, these stress hormones are in constant, damaging circulation. Author Orison Swett Marden once stated: “There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow”.  Spirituality and religion produce hope and purpose and this can provide healing that surpasses any medication or procedure. 

     One of my favorite Bible verses, “A merry heart does good, like medicine, But a broken spirit dries the bones” (Proverbs 17:22), wraps it up by telling us that hope and happiness are the optimal medicine for any ailment.  This spiritual “Xanax “could be the remedy for those suffering from a broken spirit and it is my duty to offer this to anyone in need!

Wednesday, February 28, 2018

"How do you do it?"

     This is a question that I have been asked by friends, family members, patients, and colleagues for the past decade! "How do you do it?" How can you possibly work two jobs, go to school full time, raise kids, support the Navy, home school your kids, run a business, etc, etc! From the time I decided to pursue my nursing career I have managed to juggle a number of what I would call ventures and interests rather than "responsibilities". Maybe this is why I have been able to multitask seemingly impossible feats throughout the last fifteen years. I do not see my endeavors as responsibilities, i.e. "duties", "requirements", and/or "obligations". Rather, every pursuit has been a passion, backed by extreme persistence and motivation. Regardless of any obstacles or difficulties, I have whole-heartedly followed the hopes and dreams that I set out to achieve, and I cannot belittle my immense measure of faith that has only grown stronger and unbreakable in the past five years. I now have two Master's Degrees, operate my own clinic full time, home school my two younger boys, and still manage to remain humble and sane!

Here are the secrets to my superhero mentality:

1) First and foremost, God comes first in all aspects of my life. This has not always been the case for me, but five years ago I found truth and hope that cannot be surpassed by anything in this tangible world! I am not ashamed or afraid to tell everyone what my faith has done for me, and without Him, I really do not know where I would be today, but most definitely not where I am! I will save my testimony for another blog :)

2) I focus on what I love and where my heart leads me. I do not see any of my endeavors as something "I have to do", but what "I want to do". I put my all into everything and I move forward despite any obstacles. I do not settle for anything, rather I choose my pursuits willingly and eagerly based on the gifts that I was given.

3) I do not compare myself to anyone else. Every individual has been afforded their own unique talents and gifts and no two people are the same. I do not live my life based on others, but based on what moves me and what I was made to do. On that same note, I ignore the "haters". As I always tell my kids, not everyone is going to like you, nor will everyone agree with what you do, but we were not placed on this Earth to impress others! No matter what negativity may come my way, I smile and move forward without even flinching!

4) I stay humble. I am not above anyone and I always remember where I came from. I do not strive to be better than everyone, but I strive to be the best at what I do and to help others to do the same.

5) I am optimistic! I always hear my dad's voice echoing in my head, "always think positively and learn from your mistakes!". No matter what trials I face, I remember that things could always be worse. I am always moving forward, never backwards. As the great vocalist Wintley Phipps stated, "if the mountain were smooth, you couldn't climb it"!

So there you have it! This is how I do it.....

Thursday, February 22, 2018

Humans, Not Patients

If you have not already noticed, health care has slowly grown into somewhat of a "factory" of patients, ruled by corporations, insurance companies and "BIG Pharma", and not exactly in that order. Humans have become just another number in the world of "conveyor-belt" medicine.

Long waits, short visits, and scripted, impersonal care have become commonplace in medical clinics all over the country, and in the meantime, antidepressants and/or anti-anxiety medications are on the medication list of over 10% of the American population over age 12. As a matter of fact, there is a medication to fix every ailment now, especially in a world of 15 minute visits where only one concern can be addressed at a time. This leaves just enough room to "stamp" you with an ICD-10 label and to prescribe the newest "band-aid" pharmaceutical for that one problem and to send you on your way.

Merriam Webster defines the term "health" as "the condition of being sound in body, mind, or spirit", but how can we as health care providers promote this soundness of body, mind, and spirit when we only have 15 minutes to address such a complex myriad of systems and interconnections?

We cannot blame everything on the industry of health care, however, when many health providers are unhappy and frustrated. We have a job as health providers, whether Nurse Practitioner, Doctor, Physician Assistant, etc, to care for those who entrust us with their most precious assets! This does not mean being judgmental, condescending, authoritative, and just plain rude! Instead we should open our ears and listen to concerns as if we are caring for family and friends! We have a big job to do and it is imperative that we do it wholeheartedly and to the best of our ability!