This week’s Grand Rounds is hosted by Dr. John Crippen, who writes about “the pleasures and pitfalls of family medicine in the modern British National Health Service.” I am honored that he has chosen to include my post.
To fight—or not to fight. Is that the question?
Senator Kennedy’s recent diagnosis of a malignant brain tumor has sparked an animated debate in the Boston Globe among health columnists and letter writers: Should patients diagnosed with a deadly cancer be encouraged to fight their disease, or should they focus more on quality of life and the journey towards spiritual—if not physical—healing? The “fight” proponents use the vocabulary of warfare: “vanquishing” the cancer “enemy” with every available “weapon” in the “arsenal.” One problem with this approach is that if you fight and lose, there may be guilt: Perhaps you didn’t fight “hard” enough.
The advocates of acceptance and healing say control what you can, choose your doctors and your treatments wisely, but also choose to spend time and energy on family, relationships, meaningful work, and finding joy in every moment. As one letter writer said, “Cancer is a disease, not an enemy. It also presents a deep opportunity to learn. My quest is to live each day as fully and richly as I can, to enjoy all that I have, and all the beauty and meaning of this world.”
A contrasting view came from an oncology nurse, who wrote that the notion of “fighting to win,” is too narrow: “Perhaps one’s fight could mean mustering resources against an enemy – cancer. Or it could mean winning against symptoms, or against the urge to stay at home during treatment and not work. Or beating the maze of our healthcare system, and getting the treatment you need when you need it!”
Perhaps “to fight or not to fight” is the wrong question, since there is no universal approach to illness that is right for every person. Several years ago, when I recovered from my own health challenge, and wrote my first book filled with the stories of people who fought and prevailed against cancer, paralysis, pain and deadly diseases, I thought that fighting was the only acceptable way to deal with illness.
Now, I am not so sure. Marshalling every available medical, alternative, emotional and lifestyle resource does give us more of a chance to overcome illness and injury, and perhaps to discover the latest “silver bullet” in the arsenal. But at what cost? There is also a value to the inward journey for peace, and nurturing loving connections with others. How best to combine these approaches given the limitations of energy and time?
Once, I interviewed a wise rabbi about the ways in which he helps people deal with suffering and illness. He described a state of holding two simultaneous beliefs: The desire to become well and “vanquish” the disease; while at the same time accepting the possibility of—and preparing yourself and your loved ones for—a different outcome. This is clearly very hard to do: One must gather the inner strength and energy—as well as the time—to pursue treatments, seek medical options, eat well, and think positively. All while somehow recognizing and accepting that you may not succeed. No easy answers. I’m still thinking.
More Evidence About the Health Benefits of Cold Showers
Two detailed and lengthy comments about research on the health benefits and history of cold water bathing were recently posted here. This is a fascinating dialogue, made all the more so by the care with which the writers of these comments have described their own research and sources. I appreciate your efforts and would especially like to know more about the writer called “cold shower,” whose post is dated May 22. Can you tell us something about yourself, your interests, and your work?
Filed under cold shower health benefits, Sebastian Kneipp, Water
Alexander Technique for Depression
This is the beginning of an interesting post about the Alexander Technique as a treatment for depression and mental illness: “In our culture today the connection between physical and emotional problems is gaining currency. Surprisingly, the best answer to coping with the stresses of life is by using a hands-on approach that straightens the body. This technique can help in balancing moods, changing behavioural patterns and managing life’s challenges.”
I have studied the Alexander Technique for years and found it useful for body alignment and functioning without pain. The beneficial effect on depression and psychological problems is news to me, but I can certainly believe it. Here is a link to the post. And here is a link for more information about the Technique.
Filed under Alexander Technique, depression, mental health
Grand Rounds is up
Check out this week’s excellent Grand Rounds roundup of medical/health posts in the blogosphere, hosted by David Williams of the Health Business Blog. I’m happy that my post about “The Unhealthy Health Care System” was included. Topics of other posts include the complexity of doctor-patient relationships, patient tales, wellness, health technology and health policy.
Yoga for PTSD in a Military Hospital
How progressive of the US military to use yoga as a treatment for soldiers returning from Iraq with post-traumatic stress disorder. As reported in the May 6 Washington Post, the Specialized Care Program at Walter Reed Army Medical Center focuses on helping service members returning from Iraq and Afghanistan cope with the flashbacks and nightmares typical of post-traumatic stress disorder, which affects 20 percent of the approximately 1.6 million U.S. military personnel who have served in Iraq or Afghanistan, according to a Rand study released last month. The program uses a guided meditation technique called yoga nidra, which I know from personal experience to create a profound state of relaxation.
Filed under Healing, Health, mental health, Uncategorized, Yoga
Unhealthy Health Care
We can exercise, watch what we eat, take cold showers, practice yoga and Tai chi, meditate for peace of mind. But even if we are doing everything we can to “own our health,” we’re still going to need a doctor someday. Good luck finding one.
The Massachusetts Medical Society’s 2007 Physician Workforce Study found physician shortages in primary care (family practice and internal medicine), psychiatry, and vascular surgery for the second consecutive year. Anesthesiology, cardiology, gastroenterology, and neurosurgery remain in short supply, while urology appears on the list for the first time. In public opinion surveys conducted as part of the study, the Society also found that access to primary care physicians, as well as some specialists, remains strained, and waiting times for appointments are increasing.
The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.” Fewer internal medicine residency graduates are choosing to become primary care physicians (PCPs)—18 percent in 2006, down from 50 percent in 2000—and existing PCPs are unhappy in their jobs, with many choosing to leave the field.
What this means is that it is harder and harder to find a primary care physician, and, when you do find one, it is likely that he or she is overburdened with a large patient panel and hours of bureaucratic paperwork.
How then, to create the kind of meaningful healing partnership with a physician that we all need and want? These kinds of relationships take time, something that is in short supply in this era of the 15-minute medical visit. One doctor told me, “if we just saw patients in the office the way we used to, we’d go out of business. No one can break even practicing medicine alone, because the health care finance system pays you to do things to patients—colonoscopy, MRI, CT-scan, endoscopy—not merely talk to them.”
But “merely” talking is the only way to get to know us patients; the only way to understand and help us manage the stress in our lives that may be causing physical or mental illness; the only way to educate and encourage us to make healthy lifestyle choices, to take responsibility for our health. And “owning our health” may help to make those expensive tests unnecessary or avoid even more expensive hospitalization and surgery.
iParenting Media Award just in time for Mother’s Day!
iParenting Media has just announced that Your Developing Baby has won a 2008 “Excellent Product” award. This visual tour of pregnancy through the wonders of ultrasound uses both 2-D and 3-D images, along with explanatory diagrams drawn by Peter Doubilet, MD, PhD, one of the authors. It was a joy to explore “the world within” with Dr. Doubilet and Dr. Benson, and a privilege to help them share their knowledge with others.
Filed under children's health, Health, Pregnancy, Ultrasound
Treatment for Mental Illness: Finding Balance
While we are talking about mental health, I have just read an amazing story of Duane Sherry’s intervention to help his son recover from a frightening psychotic disorder that he reports was caused by psychiatric medication. The story appears in an article on Bloomberg.cm, about overuse of psychiatric medicines for children. Mr. Sherry replaced the drugs with alternative methods and now, two years later, his son is free of all symptoms and medication. In an e-mail, Mr. Sherry commented to me that “I simply believe in the body’s own ability to heal, and that in the case of ‘mental illness’ there may be something that is out of balance in the body and not functioning correctly. This might be the thyroid, a candida or yeast infection, food absorption difficulties, lyme disease, sensitivities or allergies to various foodsor chemicals.. Whatever it is, it may be getting in the way of healthy mental function. In addition, of course there is abuse and neglect and trauma which may need to be taken into account in the treatment of mental illness. But, any sane person can see that locking people up against their will, and/or forcing them to take large amounts of mind-altering drugs is not the solution. If we had done this with my son, I believe we would have lost him.”
Filed under Healing, mental health, Uncategorized
Exercise as Medicine for Depression
Today’s Boston Globe cites several studies demonstrating the effectiveness of exercise in the treatment of depression and other mental health problems. Dr. James A. Blumenthal–a professor of medical psychology at Duke University and the principal investigator of several of these studies–is quoted in the Globe as saying, “There is growing evidence that exercise may be comparable to other established treatments such as antidepressant medications.” He also found that depressed patients who were helped by exercise were less likely to relapse after 10 months than those helped by antidepressants, according to the article. In consultation with your doctor, experts cited in the Globe suggest 20-40 minutes of exercise, including weightlifting and aerobics, 3 times a week, at a level that “makes you break a sweat,” for treatment of depression, anxiety, ADHD, addiction, stress, and aggression.
We have already seen evidence that exercise can help prevent chronic disease and hospitals around the country now have “boot camp” programs for chronic back pain. Now, there is evidence that exercise is also “medicine for the brain,” in the words of Cambridge psychiatrist and author, John Ratey, MD. So let’s get out and move our bodies! Here is the link to the article.
Filed under depression, Exercise, Healing, mental health
Own Your Health 