James K. Abshire, M.D.

Author of Live Love & Let Go

Combating Stress: You Have Power!

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

“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

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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

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“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)

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“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 7th 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.

Faith and Health

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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.

Dfaith and fitness 5epression 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.

Faith – Love – Health

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There Are Three important aspects of life that we tend to seek and develop separately. However, they are synergistically linked – improvements in one area can help us in the other areas as well.

The next several blogs will explore faith, love, and health and their interrelationships.

Faith has benefits on both our physical and mental health. Let’s start with some of the physical benefits:

  • Increased life expectancy by up to 2-8 years 1
  • Reduced incidence of meningitis2
  • Reduced alcohol abuse3
  • Reduced drug abuse4
  • Involvement in religion (prayer and attending church) lowers blood pressure5
  • Better quality of life in terminal cancer patients6
  • Decrease in coronary disease (heart attacks)7
  • Lower rates of smoking8
  • Lower rates of teenage pregnancy 9

The majority of these studies10 look at the benefits of regular religious attendance, which can be defined as weekly blog Churchchurch visits. So, from a pure numbers standpoint, is going to church worth it? Well, if you go to church routinely, then let’s assume you spend 2 hours every week, for 50 weeks a year gives us 100 hours a year spent on church services (this could be more if your clergy is extremely long-winded). If the average life is about 80 years, then 80 times 100 gives us 8000 hours over a lifetime as a ballpark figure for us to spend going to church.  There are 8760 actual hours in a year. That means that if you attend church regularly, then you spend about a year of your life going to church.

Therefore, if we spend a year of our life going to church, and as a result we gain an extra 2-8 years of life expectancy, then from a pure numbers standpoint, going to church was worth it. If this had been an investment of money, and the result doubled your investment, then most of us would make that investment.

Another way of examining this is to compare church attendance to other health improvement options, such as lowering cholesterol, blood pressure, and exercise. Various studies have shown that lowering cholesterol, blood pressure, and exercise increases life expectancy by months to a few years – on par with regular church attendance. If we look at potential cancer treatments, we are generally happy with any treatment that gives us this much added time. I’ve never prescribed going to church every week, but perhaps I should start (I just have to double check that it’s FDA approved!)blog Spirituality-and-Health-Link

While the lifestyle benefits, such as decreased substance abuse, can be accomplished without religion, this wouldn’t explain the improved quality of life for cancer patients. Future blogs will demonstrate other benefits that are not just attributable to lifestyle. There’s also nothing wrong with how church encourages better lifestyles.  We have to admit that we are people, and people clearly do better with some discipline in our lives:

-Armies are much better if they are disciplined

-Schools run much better if they have discipline

-Workplaces are more successful if they have some discipline

God gave the Jewish people laws to follow putting discipline in their lives. Their history teaches us that they always did better when they maintained that discipline. We no longer follow all of the Jewish laws (except for the 10 commandments-hopefully) but we certainly can argue that God gave us the church, and attending church puts some discipline in our lives, benefitting us.

Church attendance helps us maintain healthy lifestyles, but it also helps us recover from unhealthy lifestyles. For instance, in regards to drug abuse, we should look at the program Teen Challenge, which treats teenage and adult drug addicts.

Teen Challenge is a faith based program geared to put Christ into the life of the addict. Their success rate has been reported as 86%10, a phenomenal number as addiction is extremely difficult to overcome (typical success rates blog 98125386(1)are less than 50%11). Faith is key to improving not only the health, but also the quality of life of these people.

Finally, another aspect of religion that I’d like to briefly touch on is coping with pain.

Pain relief can come in one of two ways. First, we can pray for healing and we are healed. Probably many readers have either experienced such a miracle themselves or know someone who was healed in this way (or perhaps someone else prayed over them which resulted in healing). Not only is such an event health-giving but it is truly faith building as well. If you don’t know of an example, I encourage you to ask around at your church and I’ll bet you find someone who can inspire you.

The second way that pain can be relieved is by putting your mind in a spiritual place. If you focus your mind, thoughts, and prayers on God, your pain level will be lessened. I have experienced this on a personal level and discuss it in The Greatest Ordeal (soon to be released).

Next week, we will discuss the benefits of faith on mental health.

  1. J. Robert Subrick, “The Life and Death Implications of Religious Subsidies: A Cross Country Analysis”, Dept. of Economics, James Madison University, October 2010.
  2. Teresa Neumann, “Researchers find Huge Health Benefits in the Christian Faith”, May 2, 2011: Ariel R. Rey – The Christian Post.
  3. John Gartner, David B. Larson , and George Allen, “Religious Commitment and Mental Health: A Review of the Empirical Literature”, Journal of Psychology and Theology, Vol. 19, Issue 1 (Spring 1991), pp.6-25.
  4. Barbara R. Lorch and Robert H. Hughes, “Religion and Youth Substance Use”, Journal of Religion and Health, Vol. 24, No. 3 (Sept. 1985), pp.197 – 208.
  5. Charlene Laino, “Spirituality May Help Blood Pressure: Study Shows People Who Engage in Religious Activities Have Lower Blood Pressure”, Web MD Health News, May 18, 2006.
  6. Tracy Anne Balboni et. al, “Provision of Spiritual Care to Patients with Advanced Cancer: Associations with Medical Care and Quality of Life Near Death”, J. Clin Oncology, 2010, Jan 20:28(3):445-52.
  7. E.L. Morris, “The Relationship of Spirituality to Coronary Heart Disease”, Altern. Ther Health Med, 2001, Sept. – Oct. 7(5):96-8.
  8. Harold G. Koenig, et. al, “The Relationship Between Religious Activities and Cigarette Smoking in Older Adults”, Journal of Gerontology: Medical Sciences, Vol. 53A, Issue 6 (Nov. 1998), pp M 426-434.
  9. Michael J. Donahue, “Aggregate Religiousness and Teenage Fertility Revisited: Reanalysis of Data from the Guttmacher Institute”, presented at the Annual Meeting of the Society for the Scientific Study of Religion, Chicago, October 30, 1988.
  10. http://www.teenchallengeonline.com/about-us/how-successful-is-teen-challenge/northwestern-study-of-success
  11. www.drugabuse.gov

Welcome to the Live, Love and Let Go Website and Blog!

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It’s certainly a crazy world we live in, with tremendous changes in the last half century.

There are:

·        Strange political characters on both the national and international stages

·        Threats of global terrorism and potential chemical, biological and nuclear warfare

·        Financial pressures

·        Pressure to keep up with rapidly advancing technology

·        Changes in social norms

               The way we think, talk and act towards each other changed dramatically over the years. Case in point: Back at the beginning of the American Civil War, prisoners were handled by a ‘parole’ system. Prisoners were allowed to go back to their own side – they just had to promise not to go back to fight against their captors.

             Guess what, men back then kept their word.

             Now days, there has be a legal written contract for even the simplest of deals, and people still try and figure out ways to break the deal. On top of that, government rules and regulations seem to make everything more complicated.

             The only reliable constant in our lives is God, and hopefully our faith in God.

             This blog will discuss various aspects of building faith, as well as the advantages of having faith. Using faith, we will work on developing a positive attitude towards life. We will also look at keeping a proper and positive perspective on life.

            As in the Live, Love and Let Go book, medical and practical knowledge will be given which can be used in conjunction with our faith to develop a positive approach to the gamut of end of life issues, as well as other difficult areas of our lives.

Please feel free to write in with:

·        Stories

·        Tips

·        Questions

·        Comments to Share

·        Look for the positive and humor is always appreciated

Together, we can build a better way to help and support each other in tough times. The way we approach these issues in the best witness for our faith.

               Blog postings will occur roughly once a week. Please share Live, Love and Let Go. The intent is to help as many as we can; it’s purely not for profit as all royalties go to charity.