Sunday, December 29, 2019

Keep that resolution! The plus minus trick...

Image result for plus sign
Plus and Minus

This week's focus is on mental health. 

A new decade! The 2010’s are in the books, and it’s time to start the 20’s (a new roaring 20’s? Let's hope flapper dresses make a comeback.) The next decade can be all that you’ve dreamed of, but it will take intentional focus, hard work, and yes, CHANGE.

While every new year is a great time to reflect and make positive changes in your life, it’s even more important at the start of a new decade.  What better time to take stock of your life, to look at those things that are bringing you closer to living a full, balanced and abundant life, and those things that may be standing in the way. 

As New Year’s approaches, look a little closer at your life. I’d suggest evaluating it on at least three levels: physical, mental/emotional, and spiritual. I was recently a guest on the Carlette Christmas On Point Talk Television show and we talked about these three core areas of life, and she expands them to six adding social, financial and family as well. (To learn more about Carlette and her show click here: On Point Radio Talk .) Your own list of core areas may be longer or shorter, but regardless, look at your life through the lens of those things that are important to you in the long term. Fast forward to when you are 90+ years old, in a cardigan sweater rocking on the porch, what are the things that you consistently valued over your life? Where are you doing today that is in line with those values? Congratulate yourself. What else could you be doing? What are you doing that is in opposition to those values? What needs to be cut back on or cut out? Time to make a change.

It seems like resolutions always involve stopping something. And that’s a good thing. Who doesn’t have at least one thing in their life that they should stop doing, or at least do less of? But for many people, despite their best intentions on Jan 1, they break thier resolution with in days. In fact, research conducted by Strava on 31.5 million people showed that most people failed their resolution by Jan 12.

So what can you do? In my outpatient practice, a lot of my work with patients involves helping them to stop doing something. And it is always a three steps forward, two steps back process so remember to be patient with yourself. But those that are successful seem to have something in common. Those people who find success take the time to look at the benefit that they are getting from that bad habit. What purpose is overeating at night serving? What is gained by overindulging in alcohol or using other substances? What is the plus side of staying in an unhealthy relationship? Once a person looks at the gain, they can then identify a healthier activity/action that could also provide a similar gain, and then replace what they are giving up with that new healthier alternative. To try and just quit something ignores the fact that even bad habits fill an emotional hole in people's lives. You have to find something else to fill that emotional spot if you are going to be successful in editing out those things you  know you’re better off without.

So the simple rule to help you keep your resolution is this: do not just quit/cut back, but quit/cut back AND simultaneously add something in. Plus minus. It’s the best recipe for success.

What’s your resolution?

Sunday, December 22, 2019

The Light of Christ

Leonardo Da Vinci's Benois Madonna

This week's focus is on spiritual health. 

Last week I drove south of Reno before sunrise. I found a peaceful spot in a valley by a half-frozen stream with snow covered mountains to both the east and west. I settled in to watch the sunrise. I’ve always loved sunsets, but this was a new experience.

As I waited, I noticed how cold and dark it was. The dried out, dormant grass around me seemed far removed from the verdant green of only a few months before. The once fertile ground was now frozen, and the stream that would have been an inviting place to swim was now cold, bleak, and even dangerous.

And then the sun began to rise. From the darkness there first appeared a deep reddish hue above the snow-capped mountains. Slowly the light began to pierce the darkness, and more of the mountains became visible. And then the sun appeared, first as a barely perceptible glow and then just a small sliver before it became fully visible over the eastern mountains. As the sun rose and the temperature warmed, a beautiful low fog developed over the boggy banks of the stream—the breath of dawn as a friend once called it.

This sunrise reminded me of what the birth of Jesus represents. It is the power of God’s love to come into this world and pierce even the darkest and coldest places in our lives, in our memories, and in our world. Where there is ice, fallow land, and darkness, God’s love penetrates and transforms.  

And to me that is what Christmas is. It is the celebration of the birth of Jesus, the celebration of eternal light piercing and overcoming  darkness in all its forms.

Merry Christmas friends.

Sunday, December 15, 2019

How to make a good decision...


This week’s focus is on mental health.

This year I’m working as an outpatient psychiatrist. It seems like a lot of my work with patients involves their decisions—past, present, and even future. The consequences of past decisions that in retrospect were not in thier long-term best interest cause a great deal of mental angst. Examples include forming unhealthy relationships, using/relapsing, going off psych meds without consultation, making impulsive choices, taking the easiest path, sticking to a decision that in retrospect was wrong, etc. Making  today's decisions can also be very difficult or seemingly impossible for some people (but to quote a line from the band Rush—"you can choose not to decide—you still have made a choice.”) And others seem to get caught in a spagetti bowel of future decisions and  hypothetical “what ifs” which is a sure recipe for anxiety. And the problem isn’t just with bad decisions, sometimes choosing between two good options can be absolutely debilitating.

Making good, well thought out decisions is critical to our overall happiness and mental health. Towards that end, this week I’m sharing a decision-making tool that a trusted mentor taught me years ago when I was trying to decide if I should accept a permanent church position in New Zealand or return back to the United States. It’s a method that helps to clarify our core values and keep them in mind when we make decisions. Here’s how to do it:
  1. Make an empty chart (you can fill in rows and columns as you go).
  2. On the left side of a chart, write out each of the factors in your life that are important to you that are related to this decision. Take time doing this part. Really think about your core values and what is important to you long-term. You might need to go back and add to this list over time.
  3. Across the top of the chart write the different options you are considering. Try and be creative.  Even if it doesn’t seem realistic try and include as many options as possible. Someone once told me it takes an average of 13 different options to reach the final best option. I wonder how often we falsely limit our possibilities. 
  4. On a scale of 1-10, with 10 being highest, assign a numerical score in each box for how well that option fulfills the value/important factor that you’ve listed on the left.
  5. Once completed, on the bottom of the chart add up the numerical value for each of the options in the columns.
  6. The option with the highest overall numerical total signifies the choice that best fulfills your values. 
Here’s an example. It’s only part of that original chart from when I was trying to decide whether to accept the church position in New Zealand, or return home to the US:

Remain in New Zealand
Return to US
Meaningful vocation—serving God, answering God’s call
Proximity to my parents
Opportunities for my children
Familiar culture
Ability to support family financially

At the time this process was very helpful for me. I really hadn’t realized how important my own culture was to me, and how much I was missing my parents and that I wanted to be near them in the years to come. What felt like a very hard decision because the options seemed evenly matched prior to this exercise became clear when I saw the numerical difference. I realized that I could fulfill my vocational call in either place but that family and cultural considerations were best served by returning to the US. As hard as it was, I declined the offer to serve permanently in New Zealand and returned home.

This is just one tool to assist in making good decisions. I hope it’s helpful…

Sunday, December 8, 2019

Advent, what's that?!?

Image result for advent wreath

This week the focus is on spiritual health.

Today marks the second Sunday in Advent. As I sat in church this morning, I thought about all the things I have yet to do before Dec 25--buy gifts for family, colleagues and friends (should residents buy attendings a small gift during outpatient year?),  get a Christmas tree, and haul out the outdoor decorations so I don't feel like Ebenezer Scrooge every time I drive into my cul de sac where my neighbors' homes were already completely decorated by the day after Thanksgiving.

However, this morning as I sat in the quiet, holy space of a small  Reno congregation, I was struck by how easy it is, even for a priest, to get caught up in a secularly catalyzed "to do" list. It is so easy for December to be a month of buying, parties, activity and even competition, and forget that as followers of Christ we are called to be preparing in a different, or at least in an additional way.

The Christian calendar marks the four Sundays before Christmas as the four Sundays of Advent. The word advent is from the Latin word that means "coming". It is a time when people who seek to follow Christ are to prepare. We are to prepare ourselves for the upcoming joyous celebration of Christ's birth on Christmas day, as well as for the final coming of Christ in "power and glory." Each of the Sundays of Advent focus on a different theme.

This morning in church we prayed the following prayer (from the Book of Common Prayer):

Merciful God, who sent your messengers the prophets to preach repentance and prepare the way for our salvation: Give us grace to heed their warnings and forsake our sins, that we may greet with joy the coming of Jesus Christ our Redeemer; who lives and reigns with you and the Holy Spirit, one God, now and for ever. Amen.

In a season when we are bombarded with secular messages to prepare for the winter holidays, this prayer is a reminder to prepare in a different way. It asks us to prepare for the coming of Christ by looking at ourselves and the ways we have fallen short. And who among us doesn't have something in their life that they feel ashamed about, something they wish that they were doing differently, and/or an "I'm sorry" that needs to be said? 

Making amends for the ways we fall short (sin) is quite contrary to all that we see around us in the weeks that lead up to Christmas. But think about it. How much more authentically joyful will the celebration of Christ's birth be if you prepare yourself in addition to all of the external preparations over the next few weeks? 

Sunday, December 1, 2019

Transcranial Magnetic Stimulation (TMS) Treatment for Depression

Image result for Neurostar

This week the focus is on mental health.

Currently I'm taking part in a training to learn how to use transcranial magnetic stimulation (TMS) for patients with major depressive disorder. My training and source of information is provided by Neurostar (the company whose machine we use in the outpatient practice I'm working in this year), and I've also supplemented Neurostar's information with information from Up to Date. This week, I will briefly share what TMS is, who might be a good candidate, and some of the research findings about the effectiveness of the treatment.

TMS is non-invasive (i.e. outside of the body) and non-systemic (localized effect). Simply stated, it involves placing a metal coil (seen in the picture above) against the scalp. This metal coil generates rapidly alternating magnetic fields, which penetrate approx 2-3 centimeters into the head. There are several steps the physician must take to find the effective target area which is located in the dorsolateral prefrontal cortex.  Once identified, the magnetic fields generated leads the neurons in this area to depolarize. While the exact mechanism of action is unknown, it is likely that this discrete cortical area is connected to a network of other areas in the brain that are involved in mood regulation. The magnetic fields change pathological activity within the network.

Who might be a good candidate for TMS? First, a person should have the diagnosis of major depressive disorder. They also should have failed to receive satisfactory improvement from prior antidepressant medication in the current episode of depression. Of note, the American Psychiatric Association Practice Guidelines recommend considering the use of TMS after evidence of failure of an adequate initial antidepressant medication attempt. In practice, this means that TMS can be considered before SSRI augmentation with other antidepressants or antipsychotic medications after just one antidepressant has been tried.

And who is not a good candidate? People who have conductive, ferromagnetic, or other magnetic-sensitive metals implanted in their head or which are non-removable and are located within 30 cm of the treatment coil cannot receive TMS.   Other medical conditions also need to be assessed, including a person's risk of seizures (risk of seizure is the most serious possible adverse effect of TMS).

Multiple studies have found that patients with treatment resistant depression do benefit from TMS. Compared to placebo, TMS alone showed a 14% remission rate in depression, compared to 5% in the placebo group, and TMS combined with antidepressant medication saw a reduction of symptoms in 47% of patients, compared to 22% in the placebo group. However, TMS is less effective that electroconvulsive therapy (ECT).

This post just scratches the surface of information about TMS. If you're interested in learning more, here is a link to assist you in finding a NeuroStar doctor: click here.