Medical Monday 1: Mind and Mood

Today we're chatting about mind and mood.

Lately, I've received lots of questions about mind and mood, and what are some things that could be done to improve it naturopathically. This obviously isn't an exhaustive list and you should of course consult your own naturopathic doctor or health care provider to discuss an individual treatment plan, but here are a five mind and mood 'boosters'. 

1) Dietary Additions, like egg yolks. According to this article, titled "Eat Your Egg Yolks", the choline found in egg yolks helps healthy brain development (so eggs are very beneficial for pregnant moms). There are many other foods that help the mind and mood. Talk to your healthcare provider, dietitian, or naturopathic intern (find one here!) for more dietary support. 

2) Mood Gym. This website features exercises to help people who experience anxiety and depression. It's free, but you have to sign-up/create an account to start using the exercises. 

How about a life-size game of chess to boost your mind?

3) Mindfulness. Interested in learning more about mindfulness? I learned about mindfulness in school, but also with the help of this book.

4) Fatty Acids. The standard north american diet is heavy in omega 6 fatty acids and low in omega 3 fatty acids. The healthy ratio of omega 6 to omega 3 should be about 2:1, but research says the ratio is now more like 15:1. Yikes! Thankfully omega 3s are found in some yummy foods, like fish, walnuts, flaxseeds, and even grass-fed beef.

Salmon has omega 3 fatty acids

5) Herbal Support. This Summer, second-year students will be writing NPLEx 1 and new graduates will be writing NPLEx 2. In preparation for this major exams, many herbal supplement companies were offering deals to students on herbal mind support. Herbs like Gingko and Bocoba were selling like crazy! There are lots of herbs to help balance mood or boost memory. Talk to your naturopathic intern to find the herb support for you. 

Morning vs Night Self-Control

"The self-control of morning people is impaired at night; 
the reverse is true of night people". 

--- Daniel Kahneman, Thinking, Fast and Slow, 2011, page 41

To my Early Bird readers and to the Night Owls out there, does this statement ring true?

It does for me. I'm such a morning person (early bird) and I definitely notice that my self-discipline/self-control totally goes out the window after 8 PM. I'm so determined, focused, and controlled in the morning hours and into the early evening, but then "night time" comes and I'm a goner. I abandon my to-do lists, indulge more, and laze around neglecting chores/tasks... things I would never do in the morning hours when I am so focused! 

I'd love to hear a night owl's impression of Kahneman's idea; do they feel less disciplined in the morning?

Sleeping & Radiating

This week I have my Health Psychology and Radiology final exams. Here are two tidbits taken from my studying of these courses:

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We learned a bit about insomnia (inability to fall asleep or stay asleep) due to mental illness (anxiety, depression, bipolar disorder, etc) in Health Psychology this term. While treating the underlying mental illness is key in correcting the insomnia, as naturopathic doctors, we can also teach our patients about sleep hygiene. I've talked about sleep hygiene before on the blog, but in my Health Psyc notes, we learned some even stricter sleep hygiene principles that can be used to help get our patient sleeping at night! In addition to following those recommendations previously discussed on the blog (here and here), the patient should...

- Avoid all screens after 7 PM. No television, cell phones, or computers. The back-light of these electronics stimulate our sympathetic nervous system, our 'flight or fight' heightened response.
- Avoid reading anything work related in the evening. It may be triggering stress! 
- Avoid evening exercise. Complete daily exercise in the afternoon or morning. Evening exercise may 'wind you up'. 
- Aim to accomplish one or two household tasks each day. It will get the 'nesting vibes' flowing, will output some energy (increasing bedtime fatigue), and will keep the house in tidier, potentially more relaxing space. 
- Complete a trial period without any coffee or caffeine. Because we all know caffeine keeps us awake...

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While studying Radiology this morning, I came across this nifty chart that shows some common causes of radiation. Ionizing radiation is the worst; in fact, we were given this chart to help us understand why X-rays (ionizing radiation) and other forms of imaging should only be performed when the patient's case and diagnostic guidelines warrant it.  Don't be X-raying your patients all willy nilly! There must be specific presentations and patient identifiers (gender, age, body type, etc) for these types of procedures. 

Delusions, Hallucinations, and Illusions

Delusion: a fixed false belief. Despite evidence that states otherwise, the delusion is upheld. 

Hallucination: a sensory experience in the absence of a stimulus. You think you saw something, but your eyes didn't actually see anything. I saw a cat in the bathroom... but there definitely wasn't a cat there. 

Illusion: a stimulus is present but the sensory experience is misperceived. You saw a cat in the corner of your eye, but you perceived the sensation (the cat) as something else (a monster!).

An example of an illusion. Is this an picture of two faces or a vase? Source

Reality testing: a way to test the level of awareness that a person's hallucination, delusion or illusion is understood to be misperceptions or misinterpretations. Are you aware that you are delusional, hallucinating, or seeing an illusion, or do you think that everything is 'real'? 

Setting Intentions & Giving Gratitude

More de-stressing and mood boosting mental exercises today. These are also courtesy of my clinic intern!

Exercise 1: Start your day off right by setting intentions

Set the tone of your day by setting your day's intentions when you wake up in the morning. Right when you wake up, while you are snoozing and procrastinating getting out of bed, think about what kind of day you want to have. Set your intentions by defining the type of day you want to have. Will it be an active day? A stress-less day? A fun-loving day? A motivated day? A family-focused day? Etc, etc...

Exercise 2: Sleep better after giving gratitude

You may improve your sleep if you make happy thoughts be the last thing you think about before falling asleep. Achieve these happy thoughts by giving gratitude while lying in bed at night. You can give gratitude by answering these questions: What made you smile? What are you thankful for? What  about today made you proud? What did you do well? Etc, etc...

Squared Breathing

Exams start Monday, yikes! I was feeling a bit anxious this week and so my intern at the school's teaching clinic recommended I try this squared breathing technique to calm myself whenever I'm feeling super anxious to calm myself down. By focusing on our breath, we take ourselves 'out of our mind' temporarily. Breathing exercises like this one have been shown to help people to acutely decrease their stress and anxiety.

Directions:

Imagine that you are tracing a square with your breath (see the drawing above for an exam). Breathe in/inhale over the course of 4 seconds, then hold the breath for 4 seconds, then breathe out/exhale over the course of 4 seconds, then hold for 4 seconds before taking the next breath in. Repeat as necessary. 

Hmm?

Three Hmm thoughts today:

1) People are disturbed not by things, but by the views which they take of them. --- Epictetus. Hmm, I do suppose that we are often our worst enemy.  Our own negative thoughts are most often what cause us the most mental turmoil. 

2) What do you think of the statement: in therapy, there are no good answers, only good questions. Hmm, I think I agree, because if question are asked that spark the discovery of brand new thoughts, particularly those that you never knew you had, then the questions were better than the answers themselves. 

3) On one of my favorite blogs, Oh She Glows, a giveaway for a blender was recently featured. In order to enter the giveaway, you had to leave in her comments' section a piece of advice that you’d give to your younger self. Hmm, what advice to give...? Although I have many pieces of advice to give younger Becca, the one piece of advice that I ended up posting on her blog was:

When in doubt, just go to bed. 

A good sleep wipes away many ‘bad’ thoughts. I would tell her that many heated emotions, self-doubts, and tears would be put to rest (literally) if she had just gone to bed rather than staying up fretting. Sometimes we just need to ‘sleep on it’ and things suddenly become clearer and calmer in the morning.

Any Hmm thoughts lingering on your mind lately? 

Letter to the Future.

In my Health Psychology class, we learned a tool to help patients overcome problems in their life.  The tool is called the "Letter to the Future". You are supposed to write a letter to someone important in your life as if it were 5 years in the future. The goal of writing this letter is to look forward to the future, when life is better, when you have resolved or overcome problem X. 

How the exercise works:

- Write a short letter to someone important in your life.
- Write the letter as if it was 5 years into the future and at this time, you have overcome problem X that is currently in your life.
- Describe (in the letter) what life is like without this problem.
- Focus on what is good and new, rather than what is no longer in your life (i.e. let the letter be more positive than negative).

*** Now, go and write the letter before reading the following steps. Spoiler alert! ***

- Once the letter is written, take a look at how you've described this new life.
- What was the first thing you said about your new life? Was this something that you could actually do today? Why wait 5 years? Take the first step in creating this new life now. 
- If not, what about the second thing you wrote? ...the third? ...the fourth?
- E.g. In five years time, I start my day eating breakfast while reading the newspaper... hold that thought!  Can start eating breakfast over the newspaper today? If so, that would be one small step to reaching your future when problem X is gone. If gives you hope and the satisfaction that the problem X-free future is real, attainable, and at your fingertips. 

Year 3, Semester 1, Class Review, Part 1.

It's about time that I reviewed my Year 3, Semester 1, classes! This is part 1 (five classes today, five classes tomorrow). Here we go:

Botanical Medicine 3 - Same old, same old. We're learning about 250 herbs this semester (yikes!) in the same we we've always learned about herbs (by reading monographs).  It's pretty boring.  On Wednesdays, however (we have the class twice a week), we do cases and come up with herbal formulas.  I quite like the cases because they seem so REAL. In less than a year I'll be coming up with herbal formulas for a whole variety of health concerns, so these case exercises seem really practical. (Oh, but I will soon HATE Bot Med 3 because apparently the midterm is brutal...).

Primary Care - Also known as, 'let's play doctor' class!  I find this class fascinating. We take turns being doctor, by interviewing a patient, and then performing the relevant physical exams.  Then as a group we have to diagnose the patient, do research on the diagnosis and treatment options, then write-up a full treatment plan. It's a lot of work, but fun work! This, like the Bot Med cases, is also very practical.

Men's and Women's Health - I may never meet a patient in my life who has a Chronic Bronchitis or who has Generalized Anxiety Disorder (i.e. specific conditions), but I most definitely WILL meet a male and a female patient :P  The point I am trying to make: this class is very applicable! Everyone in the class will benefit at least from 50% of the class teachings in regards to their own personal health. We have to do a research paper in this class too and my topic is a good one, so it's been enjoyable to work on.

Health Psychology 3 - We got shafted in our first and second year psychology classes. Seriously: I want my money back!  What a joke... Anywho, I am finally learning this year!  We have new-to-the-school professors and we're learning about relevant stuff, like how to assess someone with a mental disorder and the diagnostic criteria for all kinds of mental disturbances (e.g. Major Depression, Panic Attacks, Obsessive Compulsive Disorder, etc).

Practice Management - Also known as business class.  Lots of number crunching and market discussions. We have a lot of guest speakers in this class too, which keeps things interesting. We have a big group project in this class that requires us to create a full business plan, which is excellent practice for when we have to make a real business plan in a very short period of time!

Third year is shaping up to be very, very different from my second-year experience.  Second-year was very depressing (pathology, microbiology, disease, etc, etc) as we learned how to diagnose, but this year is so-far quite uplifting as we learn how to treat! We're finally learning how to make people feel better and that is a wonderful feeling.  As of right now, I'm loving school again, including all of the silly assignments and group work that comes with third-year, because it's all making me very feel very excited for the real world which is just around the corner!  Day-after-day, and little-by-little, I'm feeling more like a doctor-to-be :)

Goal Writing.

Hope you enjoyed my Summer Scenes, it was my way of concluding my Summer posting and allowed me to officially say goodbye to my school-less days. Now, let's resume the health and medically-related posting. 

It's been a week of school. It's been a week of adjusting.  It's been a week of routine. It's been tough!

Sigh... anybody else already missing the days of Summer? 

(Also, not only have I been adjusting to spending all of my time at school, but I've been adjusting to the new found Fall weather.  Brr! It's quite chilly out there. I guess it is time to put away the flip-flops and bring out the scarfs). 

One way of re-adjusting the schedule change is to set goals.  I am a big fan (and so is my new Health Psychology professor) of writing out goals. By writing them down, you are more likely to adhere to them.  It is as if when they are written down, you suddenly become accountable and responsible for completing them.  

We learned in Health Psychology last week that properly written goals should be specific, measurable, manageable, and positively-stated. The goals shouldn't be vague (specific), you should able to measure whether the goal is completed or being worked on (measurable), the goals should be realistic and do-able (manageable), and they should be stated in a positive manner (I want to do... rather than don't do...).

The Diet Diary.

A diet diary is a tool naturopathic doctors use to take a peak at their patients' daily eating adventures.  Patients are asked to record everything they ate and drank each day, for a week. 

This is somewhat similar to the one they use at CCNM.  Found here.

Pros (of Diet Diaries):

- gets patients thinking about their diet and where their daily calories are coming from
- encourages patients to eat proper meals (because the chart is divided into breakfast, lunch, and dinner, with a spot for snacks on the side)
- allows the ND to help the patient to eat better. The diary is not something that the ND will critique, but will use as a template to make minor improvements (maybe more protein in the morning, fewer carbohydrates in this meal)
- helps address nutrient needs and/or deficiencies. The ND will be able to see if the patient is getting enough protein, fiber, vitamin C, calcium, etc, by analyzing the week's diary.
- help address water intake (a biggie; most people aren't drinking enough or don't really think about their water intake. The diary will make the patient start recording and thus thinking about H2O).
- typically, there is a spot for 'symptoms' too; meaning, if a patient eats pineapple and then has an afternoon stomach ache, or ate whole wheat toast and then felt bloated, then the doctor can begin to hypothesize some potential food sensitivities. The diary can be a starting point; sparking ideas for further health explorations.

Cons (of Diet Diaries), Part One:

- patients are consciously aware of their food being 'monitored'; they may skew their eating to 'please' their ND or may leave some things off the chart entirely. It is important to be honest with the diary and eat 'normal' during the recorded week.
- portions are often not recorded, maybe because the patient doesn't know much about portions. For example, the chart may read "spaghetti and meatballs" for dinner, but how much pasta was that? A handful or a salad bowl full? What about the meatballs? Was that 4 or 10?
- it's only a week. A week is really just a peak at a person's diet.  It's certainly better than nothing, but a month of diet recording would be ideal.

Cons (of Diet Diaries), Part Two:
(These are the things I hope to change on the diet diaries I hand-out when I am a practicing ND)

- an exercise log. What if a patient ate a salad bowl full of pasta (which seems like a lot!) but then ran 15 kilometers the next day? Or what if the patient had only salad for dinner, after the spent two hours at the gym? It is important to track activity in addition to intake to find out whether or not the patient getting enough fuel.
- a section for all drinks (coffee, pop, juice, wine, beer, herbal tea, etc, all contribute to one's diet and should be accounted for in the diary).
- number of bowel movements per day.  Some foods can promote constipation, while others make bowel movements more diarrhea-like (especially common food sensitivities, like dairy or gluten).  Bowel movements (as yucky as this sounds) is an important piece of the diet puzzle too.
- supplements should be tracked too.  Is the patient taking fish oil? Protein powder? Calcium chews?
- emotional feeling. In addition to physical symptoms (bloated, tired, headache, skin broke-out, etc) emotions should be recorded too.  Food can definitely stir-up our emotions. Did any foods make you feel satisfied, depleted, giddy, or miserable?

Doctor-Patient No-Nos.

At CCNM, we are trained quite extensively in proper doctor etiquette. There are many unofficial rules to abide by in order to have successful doctor-patient relationships. Off the top of my head and in no particular order, here are some things to avoid while in practice:

Keep it to yourself - don't talk about yourself during an appointment with a patient. Some may think that identifying with the patient will help them, but in fact in blurs the doctor-patient boundaries. Avoid saying things like "I also had a ___ last week, it was ___!" Never turn the appointment onto yourself (e.g. "lets get you eating more protein... you know, I don't know if I even eat enough protein most days"). If the patient tries to learn personal information about you, always question why they are asking and gently remind them that the appointment is about their health.

Be a blank slate - don't judge the patient no matter what they say. Aim to stay neutral. You don't want to give the patient any mixed signals. If your patient decides to divorce his wife, don't congratulate or reprimand, just be. Be there for him as he goes through the process.

Listen to their needs - really listen to what the patient wants out of each appointment. Do they want to treat their condition aggressively or are they more comfortable taking things slow? Do they want to leave with a new supplement in hand or have you recommend a treatment to complete at home, or did they simply come to chat with you or to have you look over their bloodwork? Are you pushing them too much or not enough? You can help this process by asking the patient at the beginning of every appointment what they want from it.

Have no motive - although you may have a treatment plan in mind, let appointments be guided by the patient. Do they really need acupuncture today or is it best to just sit and listen, letting them express their current frustrations? Try not to enter an appointment with a particular motive.

Edited to add: Oh, and in case you are wondering why I wrote this post... well, I recently had a bad experience with a future ND (an intern at CCNM's teaching clinic). Don't get me wrong, most interns are AMAZING, but this particular one just did everything wrong. She talked about her own health concerns, talked about herself quite a bit, was not listening to me when I explained why I came to the clinic (therefore the whole session went bonkers!), and she was definitely judging me (outwardly) without even knowing me or my case! Boo-urns. Anywho, I was glad to experience a bad intern for once as it reminded me what NOT to do when I am in clinic.

Three Types of Hunger.

Next time you reach for food or feel "hungry", take a second to assess what type of hunger you are really experiencing: mouth, heart, or stomach hunger.

Mouth hunger - you are eating to feel a certain texture or get a certain taste. You want the crunchiness of a pretzel, the doughyness of a bagel, or the smoothness of some chocolate. You want the saltyness of the chip, the sweetness of the candy, or the savoryness of cheese.

Heart hunger - you are eating to fill an emotional void. You are eating because you are stressed, bored, lonely, celebratory, etc, or are simply eating out of habit.

Stomach hunger - you are eating to fill a legitimate hungry. You haven't eaten in a while and you feel real stomach hunger pangs.

Taking a minute to stop and reflect on why you are really eating is a useful tool if you are trying to combat cravings, stop compulsive eating or binge eating, or decrease your overall caloric intake. Before opening the fridge, check in with the body to see what is it really hungry for.

Healthy Food is Real Food (...and Self-Love).

When will healthy food become real food?

I read some reviews of a healthy cookbook recently and one of the reviewers commented that he or she was disappointed that many of the recipes in the book called for "weird ingredients". I found this comment very interesting. Apparently we live a world in which "healthy food" is "weird food". I find it a bit amusing how brown rice flour and apple cider vinegar are freaky while hot dogs and candy sprinkles are totally normal. Why is it that everybody and their dogs know about Heinz ketchup and Kraft dinner, but so few know about kale or quinoa? Why isn't being healthy the norm and why are the healthy ones still the weird ones in a crowd? It boggles my mind when I think of society as a whole and its approach to health. Yet, I whole heatedly believe that a change is going to come. There will come a day when the wholesome cookbook will have recipes that call for ingredients that the majority of people not only use on a regular basis, but know why these ingredients are good for them. You may call me crazy for believing in this, but hey: a girl can dream, right?
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PJ and M's Momma recently told me that she spent a whole day doing nothing. I told her this was extremely healthy as this was what her body was craving. Now, we can't always do exactly what our body wants to do, but as much as we (responsibly) can, it is important to honor thy self. After receiving an intense Hydrotherapy treatment a couple of weeks back, the naturopathic doctor coordinating the treatment told my class to listen to our bodies after the treatment and to honor how we felt. Whether we felt energetic or fatigued, she emphasized that it is an exercise in good health to listen to our bodies. We live in a very fast-paced world, one that doesn't allow for us to slow-down and check-in with ourselves very often. But, if only for one moment a day, we listen to how we are feeling and honor the current emotion or physical state, I bet we'd all be a bit healthier. Self-love is really the definition of health, as when we take good care of ourselves, we become healthier.

While most of my Saturday was spent self-hating behind a stack of Anatomy notes, I was able to take a walk in Toronto's High Park with a friend. It was a gorgeous day and it was exactly what my body was craving. I encourage my readers to practice a little self-listening and self-love this upcoming week. And even if there is only enough time to check-in and recognize the state of the body (without actually doing anything), this exercise alone can be helpful.

Health Psychology and Healing.

A summary of some recent lessons from my Health Psychology class:

- Although most people are aware of the health benefits of exercise, a good diet, adequate sleep, etc, many people still fail to make these habits a part of their everyday life. Why? Likely due to personality, social pressures, social support system, attitude towards health, culture, habit, values, resources, etc. The motivation to work towards optimal health will come from the belief that the treatment or health protocol will bring value.

- Common reasons why people don't stick with healthy routines: the routine is inconvenient, difficult to remember, or complicated; people begin to feel a bit better and then stop their routine; people don't think that the state of their health is not severe; their set treatment plan is expensive or impractical.

- People are often confused about health because they are often bombarded by so many mixed sources of health information: people hear about health from their doctors, the Internet, television, newspapers, health magazines, health food store employees, nurses, dentists, family, friends, social organizations, universities, cultural beliefs, “old wives tales", and "common sense".

- On the topic of healing, my health psychology professor recommended the book Why People Don’t Heal and How they Can by Carolyn Myss, PhD. I hope to read this book in the future (hopefully during the summer when I have more time!).