“I didn’t know you were so stressed out…”
Glancing over at J, I focused on the orange fluorescent lights flickering in darkness through his glasses as we drove southbound on the freeway. Sensing the involuntary disappointed downturn of the corners of my mouth, I quickly averted my gaze out the passenger window so he wouldn’t see.
You didn’t know I was stressed out? Because me doing dishes at 6:30 in the morning is normal?? How could you not know?
With a sharp inhale, I willed myself back to calm while my thoughts turned to the last time I was this agitated: the night of the 2020 election when I found myself obsessively cleaning the shower at 9:45. Furiously rubbing Comet with bleach powder in a counter-clockwise motion, over and over again into a stain that had never washed out in the last 6 years. “But tonight is the night,” I’d told myself. I would bend this to my will, unlike the political process outside of my control.
It didn’t work. But boy, did I try.
It was a recurrent theme, this over-functioning response to anxiety.
Reinforced time and again, after every fire put out, every emergency dealt with. Every time I impressed someone by being so “calm” and “in control” while I took more and more on in order to avoid dealing with the scary emotion of it all. I’d spent years unraveling this learned behaviour, figuring out the difference between doing things from joy vs creating the illusion of control.
I thought I’d made so much progress, yet here I was again, falling back into the same patterns.
Was I disappointed in J, or was I actually disappointed in myself?
Of course you’re stressed, M. You got your first court subpoena for a child abuse case and you testified under oath for the first time in your life! You’re supposed to be on edge.
My thumb and forefinger massaged the furrow between my eyebrows as I took in another steadying breath.
It wasn’t what I’d expected, but then again, I’d spent all morning conjuring every worst case scenario while washing the dishes and re-arranging the bedroom furniture. Imaginary spiders fell into my eyes as I cleared out a white wall appropriate enough to FaceTime in to court. I read and re-read my well worn notes on the case, tracing my fingers across my cursive script as if the keystrokes of my documentation hadn’t already been seared into my memory. The self-doubt I’d carried for the last year and a half since I’d watched the family walk down the hall morphed into acrid regret, sucking the moisture from my throat while I gave my testimony. DHS’s stamp of approval did nothing to settle my unease.
Even then, I knew.
I knew it would hunt me down some day. I knew the name before the police office laid the subpoena down on the table, stepping away quickly so we could maintain 6 feet for social distancing while I reluctantly picked the heavy envelope up.
The prosecutor was grateful for my meticulous level of detail – courteous, deferential even.
It wasn’t me on trial, after all.
And yet… 8 hours later, traveling to our friends’ house to have a socially distanced front porch hang out on this wet Pacific Northwest March evening, I was still on edge.
“… M? I can’t hear your thoughts, you know. You have to say what you’re thinking.”
“… I’ll be fine.”
He sighed.
It’s not him, it’s you. You keep pushing him out, holding him at bay. Holding everyone at bay.
“Well, can you call someone? Like, I don’t know… someone who’s maybe testified before or… H? He’d be good to talk it over.”
“It’s already done. And I don’t feel like talking about it anymore.”
J recognized the finality in my tone and gave my hand a squeeze.
“Okay…
He opened his mouth as if to say something else, but promptly closed it.
… okay.”
I knew that flash of worry so well. The way he treaded so lightly, as not to disturb a land mine. Me, for all my “resilience”, tip-toed around to not set me off.
I hated it.
But I also dreaded hearing yet another well-intentioned person say:
“That sucks. You did your best. It’ll be okay.”
Or even worse, watching the discomfort grow on their faces as they tried to find the right words to say. Feeling the need to now comfort them after I’d dragged them down with me into the dark secrets of my mind, knowing they were never given a chance to ready themselves for what they were asking for. Providing them the opening for a quick conversation pivot yet again as we try to reckon with the words we all wish I hadn’t said.
How many times did I need to be burned by that scenario to know it wasn’t worth opening that door again?
No, in these moments I don’t need to seek out anyone’s empty reassurances or words of comfort.
I don’t need people telling me I’ll make it through.
I can tell myself these things perfectly well enough on my own.
And if it comes from me, maybe I’ll be more inclined to believe it.
What I need are 36 degree rainy nights with unsuspecting friends, snuggled in sleeping bags to keep warm outside while we try to make the best of these weird pandemic times.
I need to lose myself in the details of work from home muting mishaps and silly Uber Eats drama, mundane tales of this big wide world outside of parental negligence, daily depression/suicide screens in clinic and unhealthy coping mechanisms with a straight line to alcoholism.
I need to ground myself in “normal”.
To remember what it feels like to dabble in the mildly broken.
To remind myself I can live there too.
To convince myself to hold on to these bright spots as well as the dark.
Visceral reactions to witnessed child abuse/trauma is normal.
But if it lasts longer than a month, you may have Secondary Traumatic Stress. It’s a known phenomenon amongst healthcare professionals who take care of children who’ve suffered from abuse/neglect (which is where I first heard about this), but it also has been recognized more recently during the COVID-19 pandemic.
If you’re interested in learning more in how this relates to the ongoing pandemic, please click HERE to this AAP article: Tips for recognizing, managing secondary traumatic stress in yourself.
If you take care of children at risk for abuse/neglect, The National Child Traumatic Stress Network is a great resource as well, specifically this self-care resource. It sounds trite when you go through the checklist, but I utilized many of the practices mentioned here, including writing this post after it happened in 3/2021.
If you find your self-care efforts aren’t enough, please seek professional mental health counseling. If you’re a physician or medical student in the US, you can reach out to the Physician Support Line at 1 (888) 409-0141 for free and confidential support, 7 days a week from 8 am to 1 am EST.
We must take care of ourselves if we’re to continue doing this important work.
Much love,
M
It is a sad commentary on our current cultural worldview that sunlight is widely perceived to be harmful, a cancer-causing threat. But what does the research actually say? And does this research affect older adults differently than other people?Spectrum: For starters, we should understand that sunlight is a complex combination of photons, with different wavelengths and properties. The sun is the original full-spectrum illumination, while both incandescent and LED lights emit, as one might expect, mostly visible-spectrum light.Intensity: The other important variable is the intensity of light, measured in LUX units (a foot away from one candle): direct sun comes in at 100,000; a cloudy day at 1,000; a kitchen or office measures 500; and a living room only 50. Thats why you need to get outside.UV: At one extreme is ultraviolet light (UV), whose wavelength is slightly shorter than visible violet. With regard to our health, UV is a mixed bag.It does cause sunburns, damages DNA, and triggers the aging of skin. It is also statistically associated with malignant melanoma, although, curiously, not with increased deaths from melanoma (because these cancers are mostly treatable).On the other hand, there are numerous health benefits: UV lowers the risk of hypertension, diabetes, atherosclerosis (hardening of the arteries), blood inflammation, and COVID infections. UV also stimulates Vitamin D synthesis in the skin. A large-scale study of 500,000 Brits, with a 12-year follow-up, found that frequent UV exposure lowered all-cause mortality by 14%, with cardiovascular deaths down 21% and total cancer mortality decreased by 13%. It gives one pause to reconsider the vast sums spent on sunscreen lotions. Just wearing light summer clothing blocks 80% of UV.IR: UV radiation represents only about 3% of the sunlight that strikes the surface of the earth, while about 50% is infrared (IR), whose lightwaves are just beyond (longer) than visible reds. IR radiation is more predominant at the beginning and end of days, while UV is strongest when the sun is overhead. A thick cloud cover reduces IR significantly more than UV. In a recent superb Huberman Lab podcast, Dr. Roger Seheult touted the many benefits of IR radiation. Most severe and chronic diseases also involve mitochondrial dysfunction (mitochondria are the small organelles within a cell that produce the energy-generating chemical ATP). One aspect of aging is that we lose 70% of our mitochondrial functioning after age 40. Unlike UV, IR radiation passes through light clothing and the surface of the skin to penetrate deep into body tissues, where it significantly stimulates mitochondrial ATP synthesis.Effects: The effects of improved mitochondrial functioning are pervasive, correlated empirically with sun exposure. Dr. Seheult cited statistics demonstrating that the greatest number of all-cause mortality comes soon after the shortest day of the year, and the lowest number of deaths occurs close to the longest days.People who live far north or south of the equator where days are particularly short in winter have higher overall mortality rates, particularly in mid-winter. In a study of almost 30,000 Swedish women, avoidance of sun exposure carried the same risk of premature death, as did smoking.There is well-replicated rigorous research that moderate IR exposure lowers the risk of cancer, heart disease, diabetes, hypertension, and it reduces blood lipids and chronic inflammation. IR increases immune system response to infections, such as influenza, COVID and pre-cancerous cells.On a sunny day, just 15 minutes outside can make a big difference. If youre in a green space with lots of grasses, leaves, bushes, and trees, you can receive two to three times the IR dose because plants reflect much of the IR that strikes them (notice that most leaves dont get hot in the sun because of these reflective properties).Red Light Therapy: There are many red-light therapy devices now available if you are considering them, be sure to carefully research IR wavelengths, dosage, safety, and therapeutic benefit. One study, utilizing an IR desk unit shining only on face, neck, and hands, proved to be quite therapeutic.Forest Bathing? Dr. Seheult delighted in reminding us of the wisdom of the ancient beliefs that sunlight and fresh air promote convalescence. Forest bathing has become a thing the air around trees is infused with phytoncides that defend plants from bacteria, fungi, and insects. When inhaled by humans, they up- regulate immune functioning and lower stress levels, and reduce stress hormones. The beauty and serenity of such an environment further enhances these benefits, some of which are detectable by lab tests a month later. Furthermore, getting up with the sun (and out from behind the filtering effects of plate glass windows) helps to set your circadian rhythm, which can improve sleep patterns. Take home message: forests, parks and even golf courses soothe the soul, and the body. And early morning and late afternoon may be particularly beneficial.Sweat Benefits: Dr. Seheult is a pulmonologist who treats many respiratory infections he also reminded us about how previous generations treated patients with hot baths and hot packs, as if to sweat out infections. Its been recently discovered that body temperatures a little over 100 degrees Fahrenheit actually accelerate the production of interferon, a powerful anti-viral protein. Maybe weve been a little too quick to reduce our fevers with aspirin, Tylenol, and Advil. And maybe the saunas so favored by Scandinavians and Russians are more therapeutic than weve realized.Conclusion: As spring has sprung, we encourage everyone to get away from your screens, go outside and enjoy the benefits of the sunshine that so amply surrounds us. Residents at Kavod Senior Life have a myriad of ways to get outside, whether it be on the sunlit patio areas, in the resident gardens, on the nearby walking paths in Cherry Creek or on the many benches and sitting areas surrounding the campus. Come for a visit and see for yourself!Ben and Scott https://theagingwiselyproject.com/
By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareVietnam War veterans face unique obstacles throughout the twilight of advanced illness. For hospice care providers to tailor care to meet the needs of veterans who have served in this theater of war, they must consider the tribulations these patients face as they reach the end of their lives.The Vietnam War era was a very tumultuous time to be a soldier. The United States' prolonged involvement in a war of questionable motivation left society with disdain toward the government and its institutions, especially the military.Coupled with horrific images shown on television, constant controversy was a new reality and negative public opinion formed around this conflict, of which those serving the nation were not spared.Careful consideration is necessary when treating patients facing these traumas.Tours of duty proved to be traumatizing in many ways. Young soldiers, some having just turned 18, were drafted into a war that many of them did not believe in. They were not fighting for love of country and God; rather, they were fighting for survival and out of fear for their lives.Intimate battles in the dense jungle led many to be subjected to the horrors that come with fighting in a foreign land that was only familiar to the elusive guerilla enemy soldiers.Servicemembers did not receive a warm welcome when returning home from Vietnam, often being judged and labeled as cruel and even inhumane.Moral Injury Can Impair Mental HealthThis perfect storm of trauma led to lasting moral injury that plagues many veterans for their entire lives. Veterans returning from the war were marginalized and pushed into isolation, often turning to alcohol and substance abuse, which worsened their anxiety and exacerbated their strife.Questions like Ive never spoken about the war, can I now? Was the war moral or immoral? and Was I a good soldier? come bubbling to the surface later in life as their illnesses intensify and their defenses weaken.Careful consideration is necessary when treating patients facing these traumas.The restlessness that can result from post-traumatic stress disorder (PTSD) is often treated with benzodiazepines. In most cases, these medications can bring relief through calming the patient.Yet, there is a common trend amongst veterans who cope with trauma that results in the opposite effect.Benzodiazepines can lower the walls that Vietnam veterans have built up throughout a lifetime of suppressing trauma and negative memories. This class of medications can exacerbate the symptoms of PTSD as traumatic experiences and feelings of regret resurface. Benzodiazepine-induced inhibition of neurotransmission can even lead to agitated toxic psychosis, increased anxiety, hostility, and rage.1The Value of Compassion Along with Clinical CareRemaining considerate does not end with simply staying mindful during the planning of clinical solutions. Providing care for Vietnam veterans requires a high level of empathy.A key to an empathetic approach is taking the time to listen nonjudgmentally. Though seemingly simple, practicing nonjudgmental, open communication with patients facing trauma from war can help avoid the all-too typical responses of Its okay and You did what you had to do.These patients do not need sympathy, because they have been judged enough throughout their lives. When care teams approach them without judgment, they honor the sacrifices these heroes have made.VITAS hospice care provides compassionate care approaches that are tailored to meet the distinctive needs of Vietnam veterans. With the Veterans Administration (VA) offering hospice care as part of its medical package, VITAS team members can provide empathetic psychosocial support, while utilizing clinical solutions that help manage symptoms.The qualifications for veterans to receive hospice benefits include: A life-limiting illness Treatment goals that focus on comfort, rather than curative treatments A life expectancy of 6 months or less, if their illness runs its normal course Veterans also benefit from the option to receive concurrent care through the VA. The VA can provide curative treatments as the patient simultaneously receives symptom-managing comfort care administered by the hospice care provider of their choosing.Offering solace, while remaining compassionate when patients need it most, is too often overlooked in the busy practice of healthcare. Acknowledging the adversity that Vietnam War veterans have had to face throughout their lifetimes and adapting care approaches to meet their needs is the best way for healthcare providers to give back to those who have sacrificed so much for the preservation of freedom.1Paton, C. (2018, January 2). Benzodiazepines and disinhibition: A review: Psychiatric bulletin. Cambridge Core. Retrieved November 2, 2022, from https://www.cambridge.org/core/journals/psychiatric-bulletin/article/benzodiazepines-and-disinhibition-a-review/421AF197362B55EDF004700452BF3BC6
Maintaining proper nutrition is a crucial aspect of healthy aging, especially for seniors who wish to continue living independently and enjoying their golden years. By stocking your pantry with the right combination of nutrient-dense foods, you can empower yourself to prepare wholesome, energizing meals that support your overall well-being. In this article, well explore the top pantry essentials that should be on every seniors radar.The Importance of a Well-Stocked PantryA thoughtfully curated pantry is the backbone of a balanced diet. When you have a variety of healthy ingredients on hand, it becomes significantly easier to whip up nutritious meals on the fly, without the need for multiple trips to the grocery store. This not only saves you time and money but also helps you avoid the temptation of less-than-ideal food choices that can compromise your health.Pantry Essentials for SeniorsNow, lets delve into the specific pantry items that should be on every seniors radar. These versatile and nutrient-dense foods will serve as the foundation for countless delicious and nourishing meals.Whole GrainsWhole grains, such as brown rice, quinoa, and whole-wheat pasta, are powerhouses of fiber, vitamins, and minerals. These complex carbohydrates provide sustained energy and can help regulate cholesterol levels and blood pressure, reducing the risk of chronic conditions. Oatmeal, a classic breakfast staple, is another excellent whole-grain option that can be easily customized with fresh fruit, nuts, and a touch of honey.Beans and LegumesBeans and legumes are true nutritional superstars, offering a potent combination of protein, fiber, and antioxidants. From kidney and black beans to chickpeas and lentils, these versatile ingredients can be incorporated into soups, stews, and even meatless chili, providing a satisfying and filling base for your meals.Nuts and SeedsNuts and seeds are nutrient-dense snacks that can also be used to enhance the flavor and texture of various dishes. Almonds, pistachios, walnuts, and pumpkin seeds are all excellent sources of healthy fats, protein, and essential minerals. Keep a variety of these on hand for quick and nourishing between-meal bites or to sprinkle on top of salads, oatmeal, and yogurt.Canned GoodsCanned goods, such as tuna, salmon, and a variety of fruits and vegetables, are convenient and cost-effective pantry staples. These items often have a long shelf life, making them ideal for seniors who may not have the time or energy to frequent the grocery store regularly. When selecting canned goods, opt for low-sodium or no-added-salt options to keep your sodium intake in check.Spices and HerbsElevating the flavor of your meals is not only enjoyable but can also encourage healthier eating habits. Spices and herbs, such as garlic, ginger, turmeric, and basil, are not only packed with antioxidants but can also help reduce the need for salt, sugar, and unhealthy fats in your cooking. Experiment with different flavor combinations to keep your taste buds engaged and your meals exciting.Healthy Fats and OilsIncorporating healthy fats into your diet is crucial for maintaining overall health. Olive oil, avocado oil, and coconut oil are excellent choices for cooking, dressings, and marinades. Additionally, consider keeping a bottle of apple cider vinegar on hand, as it can be used to add a tangy twist to a variety of dishes, from salads to stir-fries.Dried Fruits and NutsFor a quick and satisfying snack, keep a selection of dried fruits and nuts in your pantry. Raisins, apricots, and cranberries provide a natural sweetness, while nuts like almonds, walnuts, and cashews offer a crunchy texture and a boost of healthy fats and protein. These shelf-stable items can also be used to add texture and flavor to baked goods, oatmeal, and trail mixes.Honey and Maple SyrupWhen it comes to satisfying your sweet tooth, opt for natural sweeteners like honey and maple syrup. These alternatives to refined sugar can be used in baking, drizzled over yogurt or oatmeal, or even incorporated into marinades and dressings. Not only do they provide a touch of sweetness, but they also offer additional health benefits, such as antioxidants and anti-inflammatory properties.Whole-Wheat Flour and Baking EssentialsFor any of your baking needs, keep a supply of whole-wheat flour, baking soda, baking powder, and spices like cinnamon and nutmeg. These ingredients can be used to create healthier versions of your favorite baked goods, from muffins and breads to cookies and scones. Experiment with natural sweeteners like honey or maple syrup to reduce your intake of refined sugars.Putting It All TogetherBuilding a well-stocked pantry takes time and effort, but the benefits are well worth it. Start by gradually incorporating these essential items into your shopping routine, and dont be afraid to try new recipes and flavor combinations. Remember, healthy eating is a journey, and by embracing these nutrient-dense pantry staples, youre taking a significant step towards nourishing your body and supporting your overall well-being in the golden years!
Millennium Physician Group, established in Port Charlotte, Florida, in 2008 and now headquartered in Fort Myers, has emerged as the premier independent physician group in the Southeast, boasting a network of over 800 healthcare providers. Our commitment to delivering exceptional care is reflected in our comprehensive range of services, which span primary care, specialty care, walk-in centers, radiology and lab services, physician therapy, telehealth, wellness programs, home health, hospital care, and more.At Millennium Physician Group, we prioritize a patient-centric approach, striving to create a truly connected healthcare experience for individuals across the region. Our philosophy is rooted in value-based care, and we consistently engage our physicians to ensure the highest standards of quality and service. By offering a coordinated and comprehensive continuum of care, we aim to be Your Connection to a Healthier Life.With a dedication to excellence and a commitment to innovation, Millennium Physician Group continues to set the standard for healthcare delivery in the Southeast. We are honored to serve our communities and remain steadfast in our mission to improve the health and well-being of every patient we have the privilege to care for.To see a full list of locations near your, please Click Here
Millennium Physician Group, established in Port Charlotte, Florida, in 2008 and now headquartered in Fort Myers, has emerged as the premier independent physician group in the Southeast, boasting a network of over 800 healthcare providers. Our commitment to delivering exceptional care is reflected in our comprehensive range of services, which span primary care, specialty care, walk-in centers, radiology and lab services, physician therapy, telehealth, wellness programs, home health, hospital care, and more.At Millennium Physician Group, we prioritize a patient-centric approach, striving to create a truly connected healthcare experience for individuals across the region. Our philosophy is rooted in value-based care, and we consistently engage our physicians to ensure the highest standards of quality and service. By offering a coordinated and comprehensive continuum of care, we aim to be Your Connection to a Healthier Life.With a dedication to excellence and a commitment to innovation, Millennium Physician Group continues to set the standard for healthcare delivery in the Southeast. We are honored to serve our communities and remain steadfast in our mission to improve the health and well-being of every patient we have the privilege to care for.To see a full list of locations near your, please Click Here
Millennium Physician Group is a leading provider of comprehensive healthcare services in Florida. With a network of over 400 healthcare providers, we are committed to delivering personalized, high-quality care to our patients. Our team includes primary care physicians, specialists, and advanced practitioners who work together to ensure our patients receive the best possible care.At Millennium Physician Group, we offer a wide range of services, including primary care, cardiology, dermatology, gastroenterology, and more. Whether you need routine preventive care or treatment for a complex medical condition, our team is here to help. We also offer telehealth services, allowing you to access care from the comfort of your home.With locations across Florida, including Fort Myers, Naples, and Port Charlotte, we strive to make healthcare convenient and accessible for our patients. Our goal is to help you live a healthier life and achieve your wellness goals. Visit our website to learn more about our services and find a location near you.