James K. Abshire Archives - James K. Abshire, M.D.

Combating Stress: You Have Power!

September 2, 2016 by Dr. James Abshire Leave a Comment

“Calling Dr. Howard, Dr. Fine, Dr. Howard”

The hospital loudspeaker blared away while the three doctors ran through the hospital with patient’s lives on the line. Mayhem everywhere. Fortunately, it was just a Three Stooges movie short. Nyuk, Nyuk, Nyuk.

But I remember experiencing those types of days in real life (although with slightly less pies flying through the air). Working for 20-plus hours and then just getting to sleep right before being called for a code blue and have to run straight from bed to a patient’s room to perform CPR with a life on the line. Trying to save patients who are septic, throwing up blood, having a heart attack, a stroke, or pneumonia, and all of that on the same day (I really hate Mondays).

Yes, I think being a doctor is stressful. A soldier in wartime is probably the most stressful occupation, but law enforcement, firefighters, and airline pilots would also rank high. But all jobs can be stressful: all it takes is a hard boss, demanding customers or a troublesome coworker. However, the level of stress can be greatly influenced by how we perceive and manage it.

There are several suggestions to lower stress levels:

Prayer and meditation
Exercise. Target 30-60 minutes a day, most days of the week
Relaxing music, most likely not something from Metallica
Hobbies and crafts. One idea is adult coloring books. Be careful with these, though, because someone recently gave me one of these to do and I got more stressed out when I realized there were no numbers to tell me what colors to use (like they have in the kids coloring books)
Try and get a good night’s sleep
Massage and warm baths
Don’t turn to alcohol and street drugs. Any perceived short term benefit will be offset by worsened problems down the line.
Talk to family, friends, a counselor or a clergy member
Forgiveness. If you hold anger or a grudge towards someone, then find a way to forgive them. It will benefit you (by lowering your internal stress levels) far more than whoever you are forgiving. For instance, injured patients who have a worker’s compensation claim or lawsuit against whoever injured them seem to not recover as well. I don’t think this is because the patient is ‘faking it’ or ‘malingering’, but rather because of increased stress over the issue. Of note, I did not originate this idea. It’s based on what other physicians have told me of their observations.
Cognitive Behavioral Therapy (CBT- see Blogs 8 and 9). If you have any negative self-talk, then you need to stop it as it only ramps up your stress levels. In fact, negative self-talk may be a big source of your stress.
Find short term goals. It helps you get through stressful times. There have been plenty of tough days where the idea grows in my mind that I can’t manage to do this for the next ‘X’ number of years. At these times I tell myself that I just need to get through that day and then I can go home and relax a bit. Thirty years later I’m still going strong.
Don’t forget to find humor in the situation….. “Calling Dr. Howard, Dr. Fine, Dr. Howard”. Don’t forget to duck when things are flying at you, and don’t forget to block when you see a two-finger eye poke coming your way. Nyuk, Nyuk, Nyuk.

Next time: Using the concepts of attitude, focus, and perspective to control stress.

Stress Avoidance

August 22, 2016 by Dr. James Abshire Leave a Comment

Life is inherently stressful. But is there anything we can do to reduce stress? We cannot completely eliminate stress, but we can reduce it as well as improve our ability to handle whatever stress that we do have.

Careful planning can reduce potential stressful experiences. Consider the example in the last blog of being chased by a bear. This stress could be avoided by:

* Don’t go where bears hang out. Listen to your mom.

* If you are silly enough to go where the bears are, then lock up all your food so as not to attract them. Either that, or cook with lots of habaneros.

* If you hear bears, make lots of noise by rapping on pots and pans to scare them away. Actually, bears aren’t scared of anything, they just don’t like rap music.

Further planning can help you handle the stress when it occurs. For instance, check out what Ranger Bob says about bear encounters:

* Stand tall, strong, look brave and pray that the bear goes away.

* Don’t bother to run unless your name is Usain Bolt, or you have a slower friend with you.

* If the bear attacks, lie down on your stomach and play dead. But remember to put on a backpack first so that the bear has to chew its way through to you. Keep your smartphone in the backpack in hopes that the bear gets into a game of Pokemon Go.

* Forget Ranger Bob, pull out a big gun and shoot the bear.

Now this type of planning is clearly helpful if you live like Grizzly Adams, but the same concept can be applied to a more conventional lifestyle.

In general, you will tend to have a less stressful life by doing the following:

> Listening to your mom.

> Apply yourself in school.

> Seek a rewarding career.

> Strive to be financially comfortable, but avoid the trap of ‘keeping up with the Joneses’.

> Go to church, pray often, and put your faith in God.

> Be smart in your choice of spouse, as well as your friends.

>Exercise regularly, at least 30 minutes a day, most days of the week.

>Get married before you have kids. Work at staying married.

> Drive defensively.

> Don’t abuse alcohol or street drugs.

> Do the right thing.

Sometimes life stressors hit you despite your most careful planning. Sometimes you make mistakes and venture into bear country. As with the bear analogy, you should not beat yourself up, but rather look for a ‘Ranger Bob’ and develop a back-up plan. Have that back-up plan in mind before things go wrong.

Examples of a back-up plan can include insurance policies or a back-up career plan. However, some stressors are very unpredictable and harder to plan for. Examples might be a major illness or sudden trauma. A back-up plan can be developed for these medical episodes and it’s called a strong support system.

The support system is a combination of family, friends, community, and church family. You develop this support system by being a good, supportive member of that support system, not with the expectation of getting anything out of it, but because it’s the right thing to do…

It was a beautiful September evening, and I had gone out to start the grill for a wonderful dinner that Caryl (my wife) had planned for my sister, Nancy, who was visiting. A mishap with an overfilled propane tank quickly changed the dinner plans. The resulting propane fire set me on fire and torched the hair and skin off my face, arms, hands, and knees. It actually set my head on fire, and in the process of rolling on the ground to put out the fire, I managed to knock a disc out in my neck, which caused subsequent nerve damage. I eventually had to spend some time in the burn ward to take the dead skin off. I also had to have neck surgery with a bone graft, plate and screws to repair the damaged nerve.

Needless to say, this was perhaps the most stressful event in my life (probably even worse than that time I took the kids grocery shopping). Immediately after putting the fire out on my head, I knew I needed to develop a back-up plan. The planned great dinner was ruined, and I knew what my back-up plan needed to be: I went into the house with my face all charred and reported to Caryl that dinner was going to be a little late. She immediately thought I must be delirious, called the ambulance and the rest was history.

The pain was tremendous, but the stress was greatly reduced by my support system. Caryl and Nancy took care of needed dressing changes. Great friends and community support helped by preparing food and doing some chores. I can only be forever grateful.

Next time we’ll look at more ways to reduce stress when it happens.

Stress

August 6, 2016 by Dr. James Abshire Leave a Comment

Today you decided to take a nice walk in the forest after you got home from work. It’s a good way to unwind after a long day. As you walk down the trail, enjoying the beauty around you, you hear some strange rattling in the nearby bushes. You step closer to see what’s causing it, and suddenly realize it’s a mama grizzly and her cub. She lets out a loud roar. Before you have time to even think, you’re darting 20 feet in the opposite direction. This is the most stress you’ve ever felt in your life. But what is stress?

Stress is our reaction to a force or event that adversely affects us. We can be stressed by a wide variety of potential forces. Some examples:

* Being chased by a bear. (I chose a bear here because bears are the funniest animal exceeding even the lobster. Hopefully choosing a funny bear will make this blog less scary for you, and less likely to stress you out. You can even imagine it’s a teddy bear if that helps.)

* Personal illness or injury.

* Illness or death of a family member or friend.

* Being robbed or assaulted. (Also, I’m told robbing or assaulting someone is also stressful.)

* Getting a new job, or promotion.

* Birth of a child. (Especially Sam)

* A troublesome boss, coworker, or employee.

* Moving place of residence, church, or school.

* A graduation or retirement.

* A new relationship or breakup of a relationship.

* Thinking about who our next president might be. Where’s that bear when you need it?

* Financial or legal problems.

* Winning the lottery. Yes, people who win the lottery tend to get stressed out and not do well.

* Going to see the doctor, or in my case, going to see the patient.

* Loss of a pet.

* A child leaving home. (Unless it’s Sam)

* Being a caregiver.

* Preparing for a vacation, reunion, or party.

* Performing a task. Deadlines. Writing a blog.

We can spend all day thinking of stressors, but as you can see, not all stressors are bad, but they still put stress on us because we have to adjust to a new situation. Stress can even be a good thing by helping us to escape a bad situation, like being chased by a bear.

When put under stress, our bodies undergo changes which can be good and even improve our chance of survival. The classic example of this is the ‘fight or flight’ response which happens when you are being chased by a bear. Under these stressful circumstances, your body’s sympathetic nervous system releases adrenaline causing your heart rate to increase, you’ll breathe faster, muscles will tense up and receive more oxygen, and the liver will release stored up energy (in the form of fatty acids and glycogen). All of this is to help you be more alert and run faster, or even fight the bear (don’t take it personally, but I have $50 on the bear). Other changes also occur…for instance our blood will clot easier so we don’t bleed as much and endorphins are released which decrease pain, and that’s important for when the bear catches us.

A few other changes accompany the ‘fight or flight’ response. For instance: the pupils dilate (making our eyes look big), hairs on the skin stand up, sweating, and relaxation of the urinary bladder sphincter muscle – which may cause you to wet yourself. This is important so that the bear can see that you’re really scared and may have pity on you and let you go, which is your last chance for survival when a bear is chasing you.

The ‘fight or flight’ response is a short term response to stress. There are numerous long term responses to stress which are harmful. They include1:

* Release of cortisol into the blood stream which weakens the immune system and makes us more predisposed to illness.

* Increased blood pressure and predisposition to arrhythmia, coronary disease, and heart failure.

* Increased headache, neck, shoulder, and back pain.

* Worsened irritable bowel and acid reflux digestive problems.

* Worsened asthma and chronic bronchitis.

* Dysfunction of the reproductive system such as infertility, erectile dysfunction, and painful menstrual cycles.

* Worsened acne and psoriasis.

* Elevated blood sugars in diabetics.

* Psychological effects such as irritability, anger, depression, anxiety, fatigue, sleep problems.

The big problem with chronic stress is that life itself is inherently stressful. The above list of potential life stressors are almost all typical life events (except for being chased by a bear and winning the lottery). In fact, I have personally experienced almost all of them. However, many of these stressors are internally generated…in other words; the stress is increased by how you deal with the problem. This gives us a chance to reduce stress, which is our goal.

Next time: Ways to decrease stress

1. Stress Management – Effects of stress, Web MD, 2016.

Willpower

July 21, 2016 by Dr. James Abshire 1 Comment

“Stay!” blog 14 aussie

Cassie gazed up at me with her one blue and one brown eye. She stared back down at the piece of cheese.

“Stay!”

Cassie looked back up at me and wagged her tail. She had played this game once before and knew she could out-wait me. She also knows that the cuter and sadder she looks, the sooner that I’ll give in and give her the ‘go ahead’. Cassie is perhaps the smartest dog I’ve ever seen. In fact, I think the only thing that holds her back is the lack of opposable thumbs (and her leash).

I’d like to think I taught Cassie the ‘sit and stay’ trick, but she actually figured it out from watching a Charlie Brown cartoon. You know- the episode where Charlie runs to kick the football and at the last second Lucy pulls it away. Cassie knows if she goes for the cheese too soon that I’ll pull it away before she gets to it. So she sits and waits for me to give the ‘go ahead’ at which point she gets her reward.

Cassie has mastered the art of ‘willpower’. The key is to focus on the reward.

Willpower…easy to say and yet, so hard to do. It certainly would help solve many of life’s problems if we only had more of it:

Obesity- willpower to eat less and exercise more
Addictions- willpower to refrain
Unwanted pregnancies- willpower to abstain
Accumulation of wealth-willpower to save
Broken relationships- willpower to overcome hard times
Name your long-term goal-willpower to delay instant gratification while you work towards the goal

Life’s temptations and the rewards of instant gratification can be hard to ignore, especially in this day and age. You have to ask yourself if the long term objective is worth it, and the answer is usually yes.

St. Augustine was one of the world’s greatest theologians, influencing all of Christianity. But before he became a Catholic priest and bishop, he had lived a colorful life. After his conversion, he struggled with the idea of celibacy. In fact, he famously said:

Lord, grant me chastity, but not yet. (Paraphrased, I believe from his book Confessions…if only I had the willpower to check and be certain)

Resisting temptation is difficult but we can strengthen our resolve. Some ideas:

Focus on your long term goal. Make sure you really want it.
Develop a strong support group of family and friends. This provides you both positive encouragement as well as someone to turn to when times are tough.
Try and be well rested. Our resistance is down when we are tired.
Exercise regularly. Our mind is better when the body is strong.
Keep the temptation away from you. Out of sight, out of mind.
Pray for strength when you are tempted. Also, prayer, meditation, and deep breathing exercises help to calm your mind, self-regulate, and make better choices.
Make willpower a habit by resisting other, smaller temptations.
Remember your faith, strengthen your faith, and try and tie your long term goal to that faith. Tying your goal to serving God will strengthen your resolve. For example, you could choose to have a goal of a healthy lifestyle (i.e. exercise and weight loss) in order to use your body to serve the Lord. Or, you could choose to save money so that you could have resources to support God’s work.
Make a plan in advance to deal with temptation when it arises. For instance, my son has a to-go box come at the start of a meal and puts half the food into the to-go box and ties it off prior to ever eating. That way he cuts potential calories in half and avoids overeating.

Once again, focus on your long term goal and keep that first and foremost, particularly at times of temptation. You will be better for it.

And now, I think I’ve earned my cheese too. Take care till next time.

The Unlucky One (Or life’s not fair)

July 8, 2016 by Dr. James Abshire 3 Comments

“It’s not fair.”

“I’m really unlucky.”

“If it wasn’t for bad luck, I’d have no luck at all.”

“I didn’t deserve this.”

“Why is all this happening to me?”

“There must not be a God or else this wouldn’t have happened.”

We’ve all had these types of thoughts when bad things happen. What are we to make of this and how do we deal with it? How could a benevolent God allow bad things to happen?

Perhaps the answer lies in comparing our (i.e. humanities) viewpoint of life events with God’s perspective. Let’s start with some examples in Biblical history of people’s response when good things have happened to them:

Adam and Eve. They were given everything – the Garden of Eden, paradise, everything they needed (except clothes). And yet, they were not appreciative, they wanted more.
The Israelites in the Exodus story. They had just been rescued from slavery. The Red Sea had been parted for them. And yet when Moses was up on Mt. Sinai receiving the Commandments from God, the Israelites made a golden calf and started worshipping it. They were not whole-heartedly pleased with God, they wanted more.
King David. He was king of Israel and according to 1 Chronicles 3, he had at least 6 wives (plus concubines) before taking the wife of another man and marrying Bathsheba. Hadn’t he ever heard of using the 7^th day for rest? Once again, a case of man not being totally satisfied and wanting more.

So when we’ve been given a lot, we continue to look for more. Just giving things to people does not help build character. In fact, it may do the opposite. Consider this:

Kids who are given everything they ask for become ‘spoiled’. Not fun to babysit.
We have more appreciation for that which we’ve worked for and earned.
We learn more through experience than just being fed information. In medical school parlance, seeing more patients is considered ‘learning opportunities’.
Painful as it may be, we learn more through our mistakes.

If we examine the human condition from God’s perspective, we realize that we inherited an imperfect world with Adam and Eve’s fall. But by going through hard times, we will truly appreciate it when we receive our eternal heavenly reward. At that point, we will be fully satisfied and will not need to repeat Adam and Eve’s mistake of seeking the tree of knowledge (although the slow learners among us will probably make the same mistake).

Now when we are suffering hard times, this stance may seem to be awfully harsh from a ‘good’ God. Before we run too far with this train of thought, we should reflect on what Christ may have been thinking at His crucifixion:

It may have been ‘this is not fair’ or ‘I didn’t deserve this’.

But it may also have been:

‘They’re really going to appreciate this someday.’

I suspect it’s this second thought that helped sustain Him through His ordeal.

It should sustain us too.

A final thought:

In the late 1960’s, Walter Mischel at Stanford University conducted an experiment on young children. The children were each given a marshmallow. If the child ate it immediately, they would only get the one marshmallow. However, if they could wait a few minutes before eating it, they would get a second marshmallow. What they found was that the children who could delay gratification were more successful later in life.

Next time… some more thoughts on willpower.

Perspective

June 27, 2016 by Dr. James Abshire 3 Comments

jka car 2 “CRUNCH!” What was that? I turned to look forward and saw the emergency phone pole. It suddenly became painfully obvious that I had been wrong. I had thought the pole was put there for someone to use the phone in case of emergency. But no, it looks like the pole was actually put there to create an emergency. I got out of the car to survey the damage…and yes, I had just totaled my car going 10mph through an otherwise empty parking lot.

I was angry at myself, but I wanted to blame whoever designed the lousy parking lot. Why on earth would they put FOUR emergency phone poles scattered out in the middle of a parking lot that’s not much bigger than your average supermarket lot? Do they really think that many people are going to have emergencies all at once? For that to occur, something major would have had to happen-like if somebody is bombing the city, in which case nobody would need to be using the emergency phones. I’d be willing to bet nobody has ever used any of the phones. One phone on the side of the fence would have sufficed. Also, they made the parking spaces so narrow that if you aren’t in an end space, then you may only have about six inches to get in and out of the car.

My embarrassment was laid bare when I had to explain the accident to the insurance lady. My responses to her questions went something like this:

“Yes ma’am, it was 7am. I was coming to work. I hit a pole in the middle of the parking lot. No, the pole wasn’t damaged – they make those things to last, but the car – not so much.”

“No ma’am, I had not been drinking any alcohol.”

“No ma’am, I don’t use street drugs.”

“No ma’am, I was not using my cell phone.”

“Yes ma’am, I hit a bright yellow emergency pole that was all by itself out in the middle of the parking lot. Did you know bright yellow poles don’t look so bright yellow with sun glasses on? Anyhow, I had looked to see there were no cars or people in that area of the parking lot, and then I had my head turned while I was looking to circle around to get an end parking space so that I could get out of my car without having to worry about whacking somebody else’s car door when I get out of my car. Next thing I knew was the pole had stopped my car. Do you know that lots of other people have hit that pole, too?”

“No ma’am, I was not doing donuts in the parking lot. Believe it or not, I’m actually a respected physician…, or at least I used to be.”

In my book, Live, Love, and Let Go, I discuss the themes of attitude, focus, and perspective. If you have a problem, whatever the problem may be, then reemphasizing on keeping a positive attitude, focusing on your faith, or looking at it with a different perspective will help with how well you cope with the situation. In the case of my totaled car, it would be easy to remain angry, mad, embarrassed, and get depressed over the situation. Instead I chose to keep a positive attitude and look at the situation from a different perspective:

There are a couple hundred people that work in my building. It was amazing that all of them seemed to know all about my car. People I didn’t even know came up to me. Instead of being completely embarrassed, I choose to feel good that so many people know who I am.
I could be upset over rising insurance rates. Instead, I’m glad that I have insurance that will give me money to help buy another used car.
My car had been a used car (2003). It’s much better to wreck a used car then a new car.
My kids are happy. They figure they have a pass in case they ever wreck a car.
My wife is happy as I’ve proved to the world that I’m human.
I’m happy that I haven’t done anything this dumb in a long, long, time.

This episode also highlighted a couple of valuable concepts to me. The first is that when you make a mistake, it’s best to just fess up and admit it from the outset. Mix in a little self-deprecating humor and people will often identify with you and even give advice. In my case, many people came up to tell me about other people hitting that pole. Advice included suggestions for a replacement car (including not to get a new one), and ‘be careful in parking lots.’ The concept of owning a mistake is something that many politicians would do well to heed.

The second important concept relates back to perspective. We all go through difficult events and times in our lives. From a perspective standpoint, it helps to ask yourself if the problem will matter 5, 10, 50, or even 100 years from now. If you project far enough out into the future, the problem will become trivial. After all, someday in the afterlife, we will be reunited with loved ones in a loving and forgiving environment. Our current problems will be small in comparison. Use this concept to ease your troubles. It will let you let you find humor when relatively small things like trashing your car happen.

We will explore another perspective on life’s difficulties in the next blog. Until next time, peace be with you and watch out for those bright yellow emergency poles…they can be hard to see! – James

Great + Attitude = Gratitude

June 6, 2016 by Dr. James Abshire 2 Comments

Gratitude can be really painful. Kind of like Rocky Balboa taking a punch. It may hurt a lot in the short run, but it will make you strong enough to win by the next fight.

Recently, our daughter, Lauren, went on a trip to Africa with her college class. More specifically, they went to Uganda, Kenya, and Tanzania. Much of the time that she was over there, they were in a technologically dark area, with no cell phone access and only able to text us infrequently. One of the first text messages that we received was of her visit to a poor school. It turned out that the school managed to teach and take care of kids for $50/month. Lauren texted us that she was so moved that she felt called to donate $100 to the school. Ouch! I’m grateful that we raised a caring daughter, but that was my $100 that she donated. By the time we saw the text, she was in another dark zone with no chance for us to respond.

Next week was a time of worry. Without the inability to contact Lauren, we had no idea if she was alive or dead. We finally received another text saying that she was called to give away her shoes, and by the way, we need to get her some new running shoes. Oh boy, another chance to be grateful for a generous daughter. I began to wonder if she was going to come home broke and naked. Me broke and her naked.

It was great three weeks later when she finally arrived home. My bank account at last felt a little more secure. But it was not the end of my gratitude when she told us details of her trip. It rhino involved:

Standing 15 feet from a wild white rhino
Her raft turning over in class 5 rapids on the Nile river
Bungee jumping 140 feet over the Nile river

This time I was grateful that I didn’t know any of this craziness in advance or I wouldn’t have let her go.

All kidding aside, gratitude is one of the most important tools that we have to help us through the physical and emotional turmoil of life. Dr. Robert Emmons1, who was one of my son’s professors at UC Davis, is perhaps the world’s leading expert on the benefits of gratitude, which includes:

Stronger immune system
Lowered pain levels
Better sleep
Lower blood pressure
More alertness
More positive emotions (happiness, joy, optimism, etc.)
More social, outgoing, and less loneliness
More forgiveness
More helpful

More generosity (I learned that the hard way from Lauren’s trip to Africa)
Decreases negative emotions such as envy, regret, and depression
More stress resistant – i.e. quicker recovery
Improved self-worth

Personally, I would attest to gratitude making me more stress resistant. I have had a series of stressful events in my life for which I have found a jka way to give gratitude. I have used them to thank God for the experiences that have made me a stronger and hopefully better person. Some examples:

I frequently had to put in over 100 hour work weeks going through medical school and residency, which was a 7 year period. These were times that were mentally grueling and physically exhausting from staying up 24 and even 36 hours at times. Marines go through ‘boot camp’ to prepare themselves for the battlefield. I think of medical school and residency as ‘mental boot camp’ to prepare for future work. For that strengthening, I am grateful.
In 2004, I was in a propane fire which took the skin off my face, arms, hands and knees. It earned me a short stint in the burn ward for debridement (having the burnt skin taken off). In the process of putting out the fire, I knocked a disc out in my neck which caused nerve damage and severe loss of strength in my arm. This required bone graft surgery with plate and screws in my neck. I’m grateful for this experience for 2 reasons. First, prior to the fire, my fear was to be a burn ward patient as I saw that as the worst part of the hospital to be. I still respect the combination of propane and oxygen, but I no longer fear being a burn ward patient. Been there, done that, and could do it again if I had to (but please God, don’t make me have to). Second, the fire gave me experience in personally handling extreme pain. In fact, the following year I had gallbladder surgery and did not need to take pain medications.
Both of my parents passed from cancer. They were both hospice patients, and I was executor for my dad’s will. While I’m obviously not grateful that they died, I am grateful that the experience gave me insight and knowledge that I utilized in writing Live, Love, and Let Go, which has helped many people.

ALiForeman The benefits of gratitude are indeed reaped by the grateful person. I heard another example of this today. Mohammed Ali died yesterday and his friend and former opponent, George Foreman, was being interviewed. In 1974, Ali beat Foreman, which cost Foreman his title. Foreman could have been bitter over this, but instead he was grateful to Ali. Foreman said he used the fight to tell stories and generate interest in his later ministry work.

I suspect Foreman’s ‘attitude of gratitude’ is benefitting him today. Foreman and Ali had similar boxing careers and yet Ali developed brain damage felt secondary to repeated head blows. To my knowledge, Foreman has been spared. In an earlier blog, I discussed how nuns with a positive attitude were spared from Alzheimer’s. One can speculate that Foreman’s attitude is similarly sparing him.

Tough times are indeed difficult. A time of grieving, pain, frustration is appropriate. snuggie-fleece-blanket-with-sleeves-[2]-218-p However, I do encourage you to find something to be grateful for. No matter how bad the situation is, there must be something good about it (i.e. it could always be worse). Give thanks. It could be for a cup of water, a warm blanket, food, a home, friends, family, and of course the saving grace of Jesus. Remember, a hundred years from now, when we are in heaven, all physical and emotional wounds will be healed. For that, we can be grateful.

Emmons, Robert, ‘Why Gratitude is Good’, Greater Good, University of California, Berkeley, November 16, 2010.

The Benefits of Relationships: Longer Lives

April 23, 2016 by Dr. James Abshire Leave a Comment

Relationships. We live in a fractured society and it seems like that is becoming more and more the case. Families are fractured-single parent homes for instance. Liberals vs conservatives. Red states vs blue states. Politically correct vs incorrect. Everywhere public discourse is becoming less and less civil. Disagreement all over the place. Everybody has their own idea of what they think is important.

We see this in the very bizarre political season that we are going through. I was talking to a patient, “Fred”, about this and he agreed, but added that he couldn’t believe that none of the candidates were talking about the most important thing.

It seems like they have talked about everything including the economy, ISIS, taxes, guns, immigration, nuclear arms, walls vs bridges, emails and even hand size. I couldn’t imagine what he had in mind so I took the bait.

“Why it’s the Great Pacific Garbage Patch!” Fred replied. “It’s a bunch of trash out in the Pacific Ocean, mostly tiny plastic particles. The fish are eating them and it’s killing the fish and destroying the ocean. Some guy sailing across the Pacific discovered it. It’s huge, about the size of Texas.”

Now don’t get me wrong; I’m all in favor of a clean environment, but I’ve got my doubts about The Great Pacific Garbage Patch. I saw a show on it once, and I was skeptical (no pictures and they couldn’t tell us where it was). Based on the show, I have my doubts; In fact, you could call me the Doubting Thomas of The Great Pacific Garbage Patch. Here are my thoughts:

I used to live in Texas. Texas is a huge place, hard to miss on your route from New Orleans to LA. Why are there no satellite photos of the garbage patch?
I’m told the plastic particles are too small to show a change on a satellite map. If that’s the case, then:

How can a plastic particle be too small to reflect or refract a photon of light? There must be a change of water color or a shadow. Something.
How can some guy in a boat see a particle that is too small to alter light rays?
How can fish see these particles enough to eat them?

There are all sorts of planes, boats and satellites crisscrossing the Pacific 24-7. Why did it take some guy in a sailboat to discover something the size of Texas?

How did the guy in the sailboat know he discovered something the size of Texas? Even when I lived in Texas, I couldn’t look out my window and know I was seeing something the size of Texas (especially when I was surrounded by all those small dust particles in west Texas.)
Why aren’t all the beaches up and down the West Coast, Alaska, and Japan covered with the stuff?
Why is there no Great Atlantic Garbage Patch? No offense to my friends and family on the East Coast but I don’t think you’re any cleaner then us Westerners. Are Europeans inherently neater than Pacific Islanders? I guess Hawaii better clean up its act. Maybe we should send some guy from Florida out in a dinghy to discover the Great Atlantic Patch.
Again, it’s the size of TEXAS, for Pete’s sake. We aren’t talking about Yeti here. There should be pictures all over the news and internet.
Yes, I am a doubting Thomas and we live in modern times. I WANT PICTURES. Don’t you think that if the original doubting Thomas had modern technology, then he would have taken a selfie with Jesus? If not Thomas, then certainly one of the twelve would have. Why didn’t the guy in the sailboat think of that? And if not him, then what about the thousands of other people crossing the Pacific every day?

All joking aside, I do know that there is trash in the ocean, and that fish will eat it, and that we should teach people to quit being such slobs. Regardless of whether Fred is right or wrong on the size of the garbage, I did start to think that maybe our politicians are neglecting to discuss a major issue. That issue is our relationships with one another.

Last century, scientists discovered a phenomenon that they call the Roseto effect.1,2 Roseto is a small town in Pennsylvania that at one time consisted of a close knit migrant community from Italy. They discovered that the town had almost no heart disease compared to other American communities. They could not attribute the improved health to lifestyle as the people of Roseto smoked and drank heavily and ate fatty foods, not the Mediterranean that you might expect.

Scientists attributed the improved health to a strong support system and close family ties. There was often three generations living in a household. There was little stress in the community and almost no crime. Faith was emphasized in the family, and parental support and guidance was solid. You can bet that attachment to family and ethics/morals were taught. I’ll bet they even taught the kids not to throw trash in the ocean.

Genetics was not the answer as when people moved out of the community, the health benefits went away. Improved family and community health improved personal health as well.

Yes, a close knit family and supportive community is an essential ingredient to good overall health. Consider this:

We arguably have the best medical facilities here in the US, and yet our life expectancy lags Japan and about 30 other countries by up to 5 years. I’m sure there are many factors for this, but a big part is probably our fractured families and social communities.

When I was growing up, half a century ago, divorce and out of wedlock childbirth was ostracized. While it’s great that we no longer look down upon single moms, we should be doing more to build up intact families. Possibilities include:

Teaching kids to respect their body as well as that of others (including thinking about their partner and the potential unborn). To be effective, this probably requires teaching and enrichment on all levels- family, community, and church- this would mean attending church on a regular basis-if not for your own good, then for the good of your child.
Programs such as Marriage Encounter (see www.wwme.org ). This is where couples spend a weekend working on communication and strengthening their marriage.
Community Marriage Policies (see www.communitymarriagepolicies.org ). These are policies where clergy hold premarital counselling classes as well as enriching and restoring existing marriages.
Public policies such as having unmarried dads pay child support.
Having community leaders voice support for such values. This would include clergy, business leaders, journalists, singers/entertainers, sports figures, and even politicians. Hey, is it so wrong to advocate personal responsibility (let’s include not throwing your trash in the ocean here too)?

On a personal note, I have seen many patients live well into their 90’s and even 100’s. Almost invariably they will a strong, supportive family being there for them.

Let’s work on it. We’ll not only be healthier, but we’ll be happier too.

Next time we’ll continue to look at the benefits of relationships on our health.

Dr. Mimi Guarneri, The Science of Natural Healing, The Great Courses, The Teaching Company Lecture 18, 2012.

Egolf, B., The Roseto Effect: A 50 year Comparison of Mortality Rates, Am J of Public Health, 1992, August 82(8): 1089-1092.

Healthy Relationships are Healthy

April 12, 2016 by Dr. James Abshire Leave a Comment

P blog 4 pic10 eople are made to have relationships. The amazing thing is how good relationships can have a positive benefit on our physical health. Let’s look at some of the data1:

Married people have fewer doctor’s visits and shorter hospital stays
Married people have less depression, substance and alcohol abuse
Happily married people have lower blood pressure (unhappily married people have the worst blood pressure)
People with loving, stable relationships have less anxiety
Long term couples have less headaches and back pain
Social support helps stress management
People in loving relationships get less colds and flu
Wounds on people in positive relationships heal faster
Married people live longer
Happiness is more positively correlated with strong family relationships than income level
People who had warm relationships with their parents have half the major diseases later in mid-life as those who did not have warm parental relationships2
Men and women who have heart bypass surgery are over 2-3 times as likely to be alive 15 years later if they are happily married. Even unhappily married men were 1.5 times as likely to survive as unmarried men.3

My wife, Caryl, and I have a very happy marriage, and I’m sure it has supported my mental and physical health on a number of occasions. In 2004, I was in a propane fire that took the skin off my face, arms, and knees. I had to have dressing changes twice a day, and I’m sure that I would have had to be in the hospital or nursing home for weeks without her there to do the care. Throughout that time, I was able to maintain a positive attitude, keep a sense of humor, and get by with a minimum of medicines despite tremendous pain. I credit Caryl for that success.

Going back further in time, Caryl provided the physical and emotional ‘glue’ needed to keep our home together while I was going through medical school and residency. These years were physically and mentally draining with work weeks that were typically 80 to over 100 hours per week. (This was before laws capped the resident work week at 80 hours maximum). I think of these years as mental ‘boot camp’, analogous to how marines and navy seals train, but only for the mind. During this time, Caryl was the life preserver that kept me afloat. blog 4 pic9

How can people have such a positive relationship? Here are my suggestions:

Keep a positive attitude and work towards common goals. Be a team.
Support each other. Give and receive. Above all, show gratitude whenever you receive.
Communication is key. One program that has been very successful is Marriage Encounter.

Now folks reading about these health benefits that are not in a positive relationship may be a little disheartened. This should not be the case as there are also great rewards to having a good support system even if not in a relationship. We’ll look at this next time.

Finally, on another note, I was talking about all this to my wife and she was inspired to pen this little ditty:

blog 4 pic 2

If you’re happy and you know it clap your hands,

If your happy and you know it and your spouse will surely know it,

If you’re happy and you know it kiss your spouse!

It doesn’t come close to rhyming, but it works for me. Gotta go now. Bye.

Rauh, Sherry, ’10 Surprising Health benefits of Love’, Web MD Health News, 2009. MedicineNet.com.

Russek, Linda G. and Schwartz, Gary E., ‘Feelings of Parental Caring Predict Health Status in Mid-Life: A 35-year follow-upnof the Harvard Mastery of Stress Study’, Journal of Behavioral Medicine, February 1997, Volume 20, Issue 1, pp 1-13.

Consumer Reports News, ‘Happy Marriage, Healthy Heart’, August 22, 2011.

Faith and Health

April 2, 2016 by Dr. James Abshire Leave a Comment

In the last blog, we looked at the benefits of faith on physical health. Now I’d like to turn to the interaction of faith and mental health.

A number of studies have looked at the benefits of faith on mental health. These studies are generally examining people who attend church on a fairly regular and weekly basis. A summary of these mental health benefits is listed below: faith 11

* Better social support1

* Better insight to medical condition and more compliant with medication2

* Lower rates of suicide3

* Improved coping skills4

* Protection against depression5

* More able to fight depression4

* Praying for someone else can benefit relationships6

* High religious involvement in elderly lowered depression and disability7

* Higher self-esteem and more positive attitude towards life8

* More hopeful of future4

* Less likely to engage in domestic violent behavior9

* Trust in God improves positive outlook9

These various benefits can be summed up by stating that regular church attenders are generally happier. This is not to say that non-believers are unhappy or that all faith focused people are happy, but on average, church going folk tends to be happier.

One of the greatest health problems in the US is depression. The lifetime incidence of major depression is about 29%.10 Depression is detrimental to both the individual and society: it damages the brain, heart, weakens the immune system, shortens lifespans, causes sleep disturbance, memory and concentration problems, increases disability, causes decreased work/school performance, and causes social and family withdrawals.

Depression can be treated with counselling and medication, but adding a reliance on one’s faith not only protects against depression, but it can help us fight it and guard against suicide.

D faith and fitness 5 epression is one of the most common complaints that I see in my general internal medicine practice. Some of these patients are in a very dark mood with a variety of problems such as chronic pain, debility, job problems, financial problems, loss of a loved one, social isolation, and suffered physical and verbal abuse. Time and time again I’ve heard people tell me that it is their faith that keeps them afloat; it is their faith that has helped them endure and fight off any suicidal thoughts.

So faith helps support good mental health. But on the flip side, better mental health can help build faith. It works like this:

If our mental health is better, then we will be happier. As a result, we also have more positive attitude and thoughts. These positive thoughts lead to positive actions, which includes more prayer that gives thanks and gratitude towards God. Giving gratitude is one of the most positive, uplifting things that we do. Being positive helps us realize the works of God in our lives, which strengthens our faith.

This interaction is exemplified in the saying of St. Augustine:

“Faith is to believe what you do not see… the reward of this faith is to see what you believe.”

In other words, looking for the effects of God in our lives helps us to see these mini-miracles. There can be nothing more up-lifting to build both faith and good mental health. Think about it.

Next time we’ll take a look at love and health.

1. Strawbridge, W., et al, ‘Frequent attendance at religious services and mortality over 28 years.’ Am J Public Health 1997, Jun; 87(6): 957-61.

2. Kirov, G., et al, ‘Religious faith after psychotic illness.’ Psychopathology 1998; 31:234-245.

3. Pelham, Brett and Zsolt, Nyiri, ‘In more religious countries, lower suicide rates,’ World, July 3, 2008. www.gallup.com

4. Bunn, Alex and Randall, David, ‘Health Benefits of Christian Faith’, Christian Medical Fellowship, 2011. www.cmf.org.uk

5. Blazer, Dan, ‘Religion/spirituality and Depression: What can we learn from empirical studies?’, Am Journal of Psychiatry, Sept 1, 2011, p. 10-12.

6. Florida State University, ‘Power of Prayer: Study finds prayer can lead to cooperation, forgiveness in relationships.’ Science Daily. May 14, 2013

7. Kaplan, Daniel B. and Berkman, Barbara J., ‘Religion and Spirituality in the Elderly.’ Merck Manual. July 2013.

8. Smith, Christian and Faris, Robert, ‘Religion and the Life Attitudes and self-images of American Adolescents,’ Research Report of the National Study of Youth and Religion, Number 2, 2002.

9. Fagan, Patrick F. ‘Why religion matters even more: The impact of religious practice on social stability.’ Heritage Foundation, December 18, 2006.

10. Kessler, RC et al. ‘Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.’ Int J Methods Psychiatry Res. 2012. Sept 21(3): 169-84.