Protect yourself from workplace stress

Our institution is in the midst of one of the largest construction projects in our history. It will involve years of construction and hundreds of workers. When you walk by the site, it's obvious that there's a tremendous emphasis on safety. Throughout the complex signs are posted that say safety is everyone's responsibility.

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

Each worker is required to wear a construction-grade helmet, protective eyewear when appropriate, steel-toe shoes and a safety harness when working above ground level. Some of the work involves creating pedestrian tunnels, and those workers receive additional instruction in the high-risk aspects of the job.

This experience made me reflect that each of us works in high-risk situations. You may not use heavy equipment or be at risk of falling, but is your work environment one of stress, deadlines and demands that often exceed your resources?

The risks are different but no less real. If you sit back and do nothing, you run the risk of a major injury, which might be a stroke, a heart attack, diabetes, or a host of emotional issues such as anxiety and insomnia. So what can you do to protect yourself?

Taking care of your physical and mental health is your best defense. You can shift the odds in your favor with a few simple rules, such as getting a good night's sleep, exercising and reaching out to others when you need help. No person is an island, and we depend on each other for strength and comfort.

What have I missed from this construction scene?

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Now updated and expanded in its third edition, and featuring revised genograms for easier reading, reflecting the growing and widespread use of genograms for clinical intervention, this best-selling text provides a standard method for constructing a genogram, doing a genogram interview, and interpreting the results. Genograms of famous families—Sigmund Freud, Woody Allen and Mia Farrow, the Kennedys, Jane Fonda and Ted Turner, Bill Clinton, Princess Diana, the Roosevelts, and Thomas Jefferson, to name a few—bring the text to life, and help to elucidate the principles of family systems theory and systemic interviewing, which form the basis of genogram work. Once these principles have been explained, the authors go on to present the important clinical applications of genograms in both family therapy and family medicine. These applications include the effective assessment of patients’ risk for emotional problems such as anxiety or depression; structural patterns among families such as divorce and remarriage; relationship patterns such as enmeshment, conflicts, and cut-offs; recent and chronic life stressors such as pregnancy, acute illness, poverty, and racism; and family life cycle transitions and developmental crises, among other uses. By providing a fascinating view into the richness of family dynamics, McGoldrick and her coauthors provide an invaluable guide to clinicians for accurately charting a family’s structure, making it easier to scan for potential problems and take proactive steps to utilize resources when necessary. 32-page color insert

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Start early to encourage healthy eating

Working with mothers-to-be and new moms, I field many questions about what foods are best to eat and which are best avoided.

My common response is, "Eat what you like." If you like spicy foods and can tolerate them while pregnant, eat them. Recipe calls for 2 cloves of garlic, but you usually add 4? Go for it.

Lots of nursing mothers wonder about broccoli, cauliflower and those other gassy veggies. Again, if you tolerate them and your baby tolerates them, keep eating them. If you think a food is making your baby fussy and gassy, don't eliminate it right away. To be sure it was that food, try it again, in a smaller amount.

My advice isn't just for moms. It's also good advice for their kids. In utero and while receiving mother's milk, a baby is also experiencing all those wonderful, unique flavors. Studies have shown that babies who are exposed to a variety of flavors are more likely to except these flavors later in life. To put it quite simply, if you want to have children who like a variety of foods, expose them early on. And keep exposing them to nutritious foods as toddlers and adolescents.

We all want to raise a healthier generation of kids — and if we lessen childhood obesity then we lessen the risk of chronic disease. Exposing kids to the flavors of vegetables, fruits and spices early is the first step to getting them to accept and eat more of these foods. This is a big win for parents and kids alike.

To your children's health,

Katherine

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Focus on the light at the end of the tunnel

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

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Teenage pregnancy: Advice for parents of teens

When my kids were teenagers, I would occasionally subject them to "the talk" during dinner. The talk wasn't about sex — it was about not having sex. They'd roll their eyes, look at each other and usually the oldest would say, "You saw a pregnant teenager today, right?" Of course that was true. Throughout their teens and early 20s, I lived in fear that one of them would get pregnant or father a baby. My fear was probably magnified by all the pregnant teens I'd encountered in my professional life.

I believe it's important to talk about teenage pregnancy with your teens and preteens — both girls and boys. Adolescents aren't known for their ability to see actions and consequences or to project into the future. They're also likely to romanticize challenging situations, such as teenage pregnancy. These tendencies might be compounded by the celebrity status of pregnant teens featured in popular reality shows on TV.

Ask your teen if he or she knows anyone who's been pregnant while still in school. Talk about how your teen's life would change if he or she had a baby. Get specific. For example, would your daughter want to go to prom pregnant? Would your son want to drop a favorite sport so he can work to earn money for the baby? Would it be possible to finish school? What would it feel like to be responsible for a helpless infant? Who would support the baby? Let your teen know that he or she can come to you with questions or concerns. Also remind your teen that it's essential to tell you if a pregnancy happens. You don't want a surprise delivery.

If you're faced with a teenage pregnancy, it's tough to predict how you'll feel. You'll probably experience a mass of emotions: anger, disappointment, fear. All of these feelings are real and you can't decide that you just won't feel them. Instead, acknowledge your emotions and work with them. If you're angry, say so. If you're caught up in your emotions and don't think you can have a productive conversation right away, let your teen know that you need to put some distance between you and the news — then agree on a specific time to sit down and discuss the decisions that need to be made.

When you talk to your teen about the options, remember that any decisions about the pregnancy are your teen's to make — including whether to keep the baby, have an abortion or place the baby for adoption. Your decisions focus on how you'll support your teen and his or her decisions. If you have strong feelings against abortion, how will you handle a decision to end the pregnancy? If you feel that keeping the baby is the wisest choice, how actively will you participate in caring for or supporting the baby?

When you talk with your teen, discuss how the pregnancy will change your teen's life — as well as how it will change your family's life. Talk finances, talk responsibilities, talk school. Talk about everything. Listen to what your teen is saying and ask how he or she is feeling. Let your teen know that his or her feelings are important to you. Above all, love your teen no matter what.

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When it comes to weight loss, there's no magic bullet

Human nature being what it is, we want to believe there's a quick fix somewhere to help us lose weight, and we just need to find it.  This belief can be strong, so strong that even when we know something makes little sense, we still want to try it, hoping that at last we've found the magic bullet for weight loss.

Consider this — if there was a magic bullet, wouldn't everyone be using it and successful at losing weight? People spend literally billions of dollars on dietary supplements. Yet, despite the promises of all the many supplements out there, virtually none of them are effective in promoting long-term weight loss.

The only over the counter product that has any effect is orlistat, which is also available by prescription. However, weight loss is usually very modest at best, and at a relatively large cost. When it comes to supplements, save your money.

Fad diets have been popular for years and the list is long. Some of them were falsely called "The Mayo Clinic Diet", and they seemed to change from year to year. Cabbage soup, grapefruit, and bacon and eggs were some of the foods emphasized on these so called Mayo Clinic diets, but none of them were associated with Mayo Clinic.

The HCG diet has made a resurgence in the past few years. Years ago, it was originally used along with a 500 calorie per day diet — anyone would lose weight eating that few calories. But it's not safe and not recommended.

Recently, I looked at some of the fad diets that were popular years ago. I didn't recognize many and hardly any of them are still around.  Most tend to run their course until the next fad comes along.

When considering a dietary program for weight loss, you should ask some basic questions:

Is it safe? Does it promote good nutrition and improve health?Is it enjoyable? Is it practical and sustainable — can you continue it for a long time to keep excess weight off?

The answer should be yes to all of these questions before embarking on any weight loss diet.

While it's tempting to jump in and try a product or program promising effortless weight loss, consider it carefully before investing time and money. The old adage holds true in this case — if it sounds too good to be true, it probably is.

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New antidepressant offers hope

For those of you with depression who've been struggling to find the right antidepressant medication, the introduction of a new antidepressant is always a hopeful event. Recently, the antidepressant vilazodone became available to U.S. patients. The trade name of this new medication is Viibryd.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

The mechanism action of vilazodone is somewhat different from many antidepressants. While vilazodone does inhibit the reuptake of serotonin like so many other antidepressants, it's also a "partial agonist" of the serotonin 1A receptor. This second mechanism may be particularly helpful for some people based on the receptivity of their serotonin 1A receptor.

It's not clear who will be most likely to respond well to vilazodone as a result of its effect on the serotonin 1A receptor. However, future research focusing on differential response may well lead to clues that will help us identify who will respond to vilazodone.

The metabolic profile of vilazodone makes it quite likely that most people will be able to tolerate it at the recommended dose. However, since vilazodone is metabolized by the cytochrome P450 3A4 enzyme, a small number of people who have deficient copies of the gene that codes for this enzyme are unlikely to tolerate vilazodone at the standard dose. This problem with tolerance will also be true for people who have a normal metabolic capacity, but who take medications that inhibit the function of the 3A4 enzyme.

One of the most attractive aspects of this newly released antidepressant is that the initial clinical trials reported a quite low incidence of sexual side effects. If these initial reports are confirmed as larger numbers of people are treated, vilazodone will clearly become the antidepressant of choice for those who have struggled with sexual side effects while taking either the SSRI's or the SNRI's.

At this point, there's been little pharmacogenomic research focused on this new drug. However, as individualized molecular psychiatry becomes more prominently practiced, future research will hopefully provide some clues as to which of you will be most likely to respond to vilazodone.

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Anger: A normal emotion for Alzheimer's caregivers

Doug and so many of you wrote about the perplexing nature of acceptance.  Many of you agreed that accepting your situation as it is offers up room for ease and coping, but nevertheless isn't easy.

As Doug wrote, "accepting is not a onetime process...it is a work in progress". And Joy wrote, "Sometimes we just get tired out and have to holler." How true those statements are!

Acceptance isn't the same as liking it, and acceptance doesn't mean we aren't allowed to get angry. You, as caregivers, have every right to feel all of your emotions and to let them out. You're entitled to bad days — no judgment or apology necessary.

Although Joy recognizes her anger, not all caregivers can see it in themselves. Often you may not be in tune with your emotions because you're immersed in someone else's needs and consumed with the tasks at hand.  Yet you live in extraordinary circumstances and have understandable reasons to be angry.

You take on difficult and unpleasant tasks and often feel unappreciated. You have little time for yourself and less time for friends and personal relationships. In addition, you often set unrealistic expectations for yourself and often believe it's a sign of weakness to ask for help, or believe that no one can do the job quite like you can.

It's common to feel anger toward the one you're caring for.  Sometimes, the anger may be a symptom of the fear most caregivers experience when faced with such an ambiguous loss. Undoubtedly, caregivers are at risk for feeling angry. However, feeling angry isn't the real problem. As caregivers you're entitled to (and should) feel anger if that's what you feel. The problem comes with not knowing what to do or how to relieve the anger.

An excellent booklet titled "Pressure Points — Alzheimer's and Anger", from the Duke Family Support Program at Duke University Medical Center, states that anger is a normal and expectable emotion. The booklet offers ways of responding that support the caregivers' well-being and that of the person they're caring for.

I'm going to highlight some of the ways to manage anger in my next blog. But for now, I want to leave you with an excerpt from the booklet and ask that you offer some thoughts on your own anger triggers (or pressure points) and what, if any, helpful ways you respond when you get angry.

"Anger is an emotional response to a grievance, real or imaginary, in the past, present or future. The pain of anger is very real. If we don't know how to relieve it the right way, we will react to it in ways that make things worse instead of better."

— Mitchell Messer as cited in the booklet "Pressure Points — Alzheimer's and Anger"

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Understanding hypoglycemia unawareness

A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy

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Think multitasking saves you time? Think again

We're always reminded, especially in our younger years, of the importance of staying focused and not getting distracted. I write about this frequently in this blog, but sometimes I don't follow my own advice. Let me explain.

If the stress in your life is more than you can cope with, get help right away.

National Suicide Prevention Lifeline
1-800-273-TALK (8255) Go to the nearest hospital or emergency roomCall your physician, health provider or clergyNational Alliance on Mental Illness
www.nami.org
1-800-950-NAMI (6264)

A short while ago, I was invited to speak before a professional audience. As happens on occasion, one or two colleagues came up to the stage and asked if they could have my presentation on a USB flash drive. Of course I agreed. The procedure to do this is somewhat complicated and requires some focus on my part.

As I was trying to accommodate this request, another colleague came up to me and asked some very complicated questions. When my computer nearly melted down, I realized that I couldn't simultaneously complete the task and respond to questions. I then had to spend precious time dealing with the technical tsunami I'd created for myself.

Let me give you another example of why staying focused is so vital. A week or so ago, my wife and I had blocked out several hours on our calendars to pack and prepare for a trip. Despite that, we both accepted a number of other commitments for this time. We became distracted. We lost focus and energy and, as a result, we failed to follow some basic rules of travel, such as making sure we had our passports, confirming flight times, and so on. As you can imagine, our trip was punctuated by a number of misadventures.

These experiences served to remind me of the importance of protecting my time so that I can focus on the task at hand. Some lessons take repeating, I guess. Can anyone relate?

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