Temporary Disability from Nowhere

One month ago, my wife, Mary, and I left the U.S. for a two-week trip to Europe. The first week we were to spend with my daughter, Marissa (the co-author of this blog), her husband, Oriol, and their four young children. The family lives in Andorra la Vella, the capital city of the small country of Andorra, nestled in the Pyrenees Mountains between France and Spain. For the second week, Mary and I had arranged to take a guided hiking trip conducted on the Dalmatian coast of Croatia. The trip from our hometown of Indianapolis began with a 2-hour flight to New York City, then a 7-hour flight to Barcelona. Following a 3-hour wait in the airport, we loaded our heavy luggage into a bus for the 3-hour drive to Andorra la Vella. Once we arrived there, we were greeted by the entire family, unloaded our suitcases and then pulled them the half-mile or so to reach Marissa’s apartment.

Some 5 minutes after arising the following morning, I was struck by an excruciating pain which began in my left hip and shot down through my leg, ending below the knee. It felt as though I had been stabbed, and I immediately collapsed onto the bed. This action lessened the pain, but I still had a strong tingling sensation the length of my leg. I spent the next 36 hours being both unable to stand in an erect position nor able to walk more than a few steps. We summoned a local physician the following day. House calls are not uncommon in Andorra, and within 20 minutes, the physician was doing a physical exam and taking an oral history. A diagnosis of sciatica was soon reached, and prescriptions for pain medication, a muscle relaxant, and a series of 6 daily steroid injections were provided. We were also told that there would be no hiking trip to Croatia and that the duration of sciatic pain was unpredictable. Thank goodness, Mary had earlier insisted on signing up for trip insurance. We could also spend that additional week with Marissa’s family.

Within two hours, a nurse arrived at the apartment to administer the first of my injections. The next morning I discovered that by bending forward, and shuffling with my hands grasping the fronts of my knees, I could fairly effectively avoid serious pain and walk short distances. This gait strongly resembled that of an orangutan, and only occasionally did I venture out of their home to get a café con leche and sweet roll. The next 6 days passed in a similar fashion; the injections had been completed, but I was not much improved. Fortunately, Marissa is a physical therapist and provided me with a great deal of helpful and realistic information initially and thereafter. Moreover, I had a great deal of time available to read about sciatica! I discovered that sciatica is not a definitive diagnosis, but rather a set of symptoms, including pain and numbness that radiate down the leg. In the majority of cases, it is caused by a displaced or herniated disk in the lower spine, and is quite a common malady.

The diagnosis is often derived from the patient’s description of what they have been feeling, and involves taking a medical history and conducting a physical exam. If additional testing is indicated, it generally involves the use of x-rays or an MRI. The major goal of treatment is to reduce the pain and increase mobility. Generally with a reasonable amount of rest, cautious movement and lots of patience, the condition will go away without treatment within 4-6 weeks. Exactly why this happens is not well understood. Pain relievers, usually NSAIDs, are often prescribed. Physical therapy and stretching exercises can help strengthen muscles in the abdomen and around the spine, which may relieve pressure off the disks. Surgery to relieve pressure on the nerve can be an option. However, several research study results suggest that after a year or two, outcomes for surgical patients are roughly the same as those treated conservatively (physical therapy and/or pain relievers). Since roughly 80% of sciatica patients with displaced disks get better without surgery, a conservative approach is generally recommended. However, if your sciatic pain is chronic and unrelenting, surgery remains a viable option.

It is impossible to prevent every case of sciatica, but perhaps its risk may be reduced by taking certain cautionary steps. Proper lifting techniques are recommended when attempting to move heavy weights. Since cigarette smoking is associated with disk degeneration, avoiding smoking is important. As previously mentioned, regular exercise can help strengthen back and abdominal muscles. Naturally, striving to attain good posture, whether standing, sitting or sleeping, may be beneficial.

Tomorrow (July 17) is the 4-week anniversary of the onset of my sciatica symptoms. I am grateful that I have improved roughly 5% each day since the onset and up to the present time. Yesterday, my electronic step counter indicated that I had walked some 12,000 steps without any significant discomfort. I would like to add one additional side-note to this story. At the conclusion of our two-week trip, I required wheelchair assistance at the airports in Barcelona, Rome, Toronto and Indianapolis to reach home. I was amazed at how helpful and dedicated all those involved with these procedures were. It was clear that they were very caring and dedicated individuals. By the same token, this was the first time in my life that I had ever been in the position of being a physically disabled person. To perform even the simplest tasks often required outside help for me. At times, I felt inadequate, and did not enjoy all the attention and the loss of control that was involved. Fortunately, I was traveling with my wife who consistently provided me with non-stop loving attention, without being overly solicitous. But I have come out of the experience with a much greater empathy for and recognition of the difficulties that our disabled population has to face on a daily basis.

Jim McDonald
July 16, 2016

Having a SMART Summer (Part 1)

There will be a two-part blog posting today. The first will explore goal-setting and how important it is in changing behavior in a positive way. The second will focus on the importance of directing everyday thinking toward positive thoughts while minimizing negative ones. The two will go hand-in-hand in enhancing the chance for having a more pleasurable and effective life. We will then take a 3-week break while following some of our own advice and enjoying the adventure of travel opportunities.

I recently listened to a friend describe herself as being caught in a rut. She wasn’t particularly looking forward to the summer and was having a tough time finding motivation to start any new projects. Having known her for several years, this wasn’t a surprising discussion as we have had it before. She tends to cycle through moments of excitement and optimism, expresses a desire to accomplish a million different things, only to seemingly burn out before most of them have even been attempted. Whatever the goal, whether dieting, exercising, professional or family-related, they are usually broad, general declarations of things she would like to accomplish. Many times I listen and think the goal is unrealistic either because it is too general or there are outside factors that will prevent it from being achieved, or because it sounds like it is someone else’s goal, not really hers. Repeated underachievement leads to a feeling of frustration, the sensation of not having control, decreased motivation and even depression. But there are strategies to set yourself up to accomplish more of your goals thus leading to improved motivation and a sense of control over your life.

One tool to help direct where your time is being spent was introduced to me many years ago when I worked for a Fortune 500 company. It was mandatory for each sales rep to complete a document every week with 5 SMART goals. SMART is a mnemonic acronym to guide in setting goals or objectives. The first-known use of the term occurs in the November 1981 issue of Management Review by George T. Doran. There is some variation in what each letter stands for, but one interpretation is:

S- specific
M- measurable
A- attainable
R- relevant
T- timely

Paul J. Meyer describes the characteristics of S.M.A.R.T. goals in “Attitude is Everything”. A specific goal means that it is clear and straightforward. Specific goals will usually answer the what, where, why, who and which. A measurable goal stresses the need for measurable criteria towards attaining the goal. How will you know when the goal is accomplished? The third criteria, in my opinion, is critical. It must be attainable or achievable. I touched on the topic of what can happen when goals are unrealistic and a person repeatedly falls short of their goals. It can lead to a sense of worthlessness and a feeling of failure. In a professional setting, it is also extremely important to recognize the constraints that you are working within. Setting a goal to sell 500 units of a product when only 300 are available is not achievable due to circumstances beyond your control. It is an important exercise to be able to analyze your environment to be aware of how to set yourself up for success.

A relevant goal is one that matters, and is appropriate to the specific situation. For a 75-year old diabetic who has been bedridden for 3 weeks, a relevant goal may be to stand up 3 times a day. Obviously this would not be relevant for the average 45-year old woman whose goal is to lose 10 pounds. But these are your goals, not someone else’s. Take an honest look at your strengths and weaknesses and set your goal around your priorities. Finally, a timely or time-bound goal is one that has a commitment to a specific date or time. Someday, or later frequently lead to never, or not at all. A timely goal establishes a priority.

An example of a SMART goal might be: I will walk the dog for 30 minutes continuously, 4 times a week for the next 2 weeks. Having a weekly calendar hanging in a visible place will assist in successfully accomplishing this goal. It is simple to print out and it is motivating to make a check mark when the goal has been executed. Is it apparent how this goal could lead to more of a sense of accomplishment and control over your life than: I will walk the dog almost every day. The later goal is not specific. How far or how long will you walk the dog? It is not measurable: what does almost every day mean? I suppose it is attainable, but as it lacks the other criteria, it fails to produce a sensation of accomplishment. It may be relevant because clearly a dog needs to go outside every day. It is not timely because it has no end, for a week, a month, a year???

I recently viewed a “TEDx talk” about why some people find exercise harder than others. The speaker was social psychologist Emily Balcetis, and she explores perception, motivation, goal-setting and decision-making from conscious and non-conscious levels. She talks about vision and that what we see is actually filtered through our own mind’s eye. For example, research has shown that dieters actually perceive an apple to be larger than someone who is not dieting. Likewise, some people may literally see exercise as more difficult than others; people’s state of their own body changes their perception of the environment. In a research study, people who were less “fit” perceived a finish line to be further away than those study participants who were in better shape. Our bodies and our mind work in tandem to change how we see the world around us. When people´s motivation was factored into the equation, people who were less fit but highly motivated saw the finish line closer than those who were more fit but unmotivated. The point is that setting SMART goals can help motivation which in turn can affect the body’s actual performance. The strategy of “keeping your eyes on the prize” has shown to be effective in helping people attain their goals. In Balcetis’ study, it made the finish line look 30% closer, it made the exercise feel 17% easier, and yet the people moved 23% faster, indicating that they were working harder.

Next time you are feeling unmotivated, you can call on a few strategies to alter this perception. Why not take a minute and write out a SMART goal. The chances of you being successful after running through the exercise of establishing a SMART goal are a whole lot higher than achieving a goal of : “I need to lose 10 pounds”. Secondly, realize that we see the world through our mind’s eye. Keeping your “eyes on the prize,” or in other words, envisioning your specific goal, can improve subjective perceptions and even improve objective performance.

Marissa McDonald
June 16, 2016

Positive Thoughts Can Make Good Things Happen

Part II explores a simple, yet important concept to improve both your mental and physical health. Roughly 500 years before the time of Christ, the Buddha reportedly stated, “The mind is everything. What you think you become.” In Proverbs, it is phrased “For as he thinketh in his heart, so is he …” Through the centuries, many noted philosophers have generally agreed “You are what you think about.” Perhaps we could add a different twist and say “You become what you think about.” We now have a considerable amount of scientific evidence supporting this view as well. This does not mean if you sit around thinking you will someday win a gold medal in the Olympics, that eventually the gold will be hanging from your neck. What it does mean is that most of us vastly underestimate the power of our minds and that we can – with practice and dedication – control our thoughts in a positive way.

It is estimated that we typically have some 50,000 thoughts a day. This stream of thoughts is endless. They may be positive, neutral, or negative in nature, and their essence dictates your reality by providing either joy and pleasure … or pain and suffering. So when you are not in a positive mind-set, imagine how many negative thoughts you generate each day … thousands and thousands. And it is these negative thoughts that reduce the joy of life. But this need not be! The fact is that we can direct our thoughts, and using this power we can to a degree become what we think about. We may begin by saying YES to life in general. Imagine your life the way you want it … create a picture in your mind and focus on that picture steadfastly all day long. Deal with the obstacles you face with a logical plan of action. Over time, you will become what you think about!

There are two major challenges for maintaining positive thinking and good mental health: (1) accurately interpreting events taking place around you, and (2) dealing with your negative emotions. In the former case, many of our interpretations of events are inaccurate and skewed toward the negative. Similarly, many of our negative emotions arise from self-talk. These kinds of negative conversations that take place in our heads can become self-fulfilling prophecies. When events in life don’t go our way, we often look for others to blame. However, this is not a productive emotional strategy and it requires a great deal of energy. It also interferes with thinking about the positive things happening in our lives. You can stop the negative chatter in your brain. The most important step is to simply become more aware of when you’re thinking negatively. Pay close attention to how you talk to and about yourself. Recognize when you think, “I’m no good at this; someone else causes my problems; the cards are stacked against me.” Keep a journal for an hour each day and note how many times negative thoughts creep into your thoughts. And then realize that this outcome is not in your best interest.

A direct relationship exists between our degree of happiness and our longevity. This has been demonstrated in several studies. We must keep in mind that happiness and sadness are states of mind. They are choices we continually make. Most emotional pain is self-generated and is a reflection of how we interpret events. We have the choice to manufacture either happiness or sadness every moment. We can say YES or NO to the countless choices we each encounter every single day. It isn’t so much what life brings to us, as it is the attitude we bring to life. We spend our lives worrying about what the future might bring, complaining about our present situation, what we are missing, our past regrets. But worrying about the past and future is fruitless. If we have no control over a situation, why worry? And if we do have control, why worry?

Positive thinking is one of the hallmarks of self-improvement and a healthy lifestyle. It allows you to look beyond what’s happening in the moment to the bigger long-term picture. Science has repeatedly demonstrated the benefits of thinking positive thoughts. This kind of outlook to life translates to greater creativity, higher levels of learning, and enhanced personal growth. It also improves your relationship with others and nurtures better physical and emotional health.

For some, daily meditation can help increase awareness of our sensations, feelings and state of mind, and to create a type of positive energy. Long-term meditation has been shown to physically change the brain, which is not a physically static organ, in positive ways. In any case, whether or not you totally accept the concept of becoming what you think, we can all agree with Henry Ford’s philosophy.

“Whether you think you can or think you can’t, your are right!”

Jim McDonald
June 16, 2016

Summer Travel Issues

Because of travel plans during the next month, we will have one or two postings this coming week, but then none thereafter until July 10. In the meantime, keep living a healthy, fun-filled existence!

Marissa
Jim
June 12, 2016

A Trip, Not Travel for a Child’s Delight

With Marissa and her family having just traveled to Portugal, and Jim and his wife, Mary, returned from Ireland, it seems like a perfect time for Marissa to share some of her travel tips and experiences on how to minimize travel stress while accompanied by four young children.

The arrival of summer often brings with it the opportunity to travel. For those with kids at home, the restraints of school have lightened and now you are faced with other challenges. Like, what in the world am I going to do to keep my sanity with these children out of school for the next 2 and a half months?!!! Although summer tends to be a more expensive time to travel, it usually has the advantage of better weather and lots of festivals, planned activities and events sponsored by local governments. Everyone is looking to capitalize on the dollars that tourism brings: zoos, parks, museums, and libraries all organize summer events. Traveling with the family can be as simple as heading over to a neighboring state to see a waterfall or as complex as hopping on a plane to dive into a culture different than your own.

A “trip” seems like a much more feasible thing to accomplish with kids than to “travel”. A trip indicates you have a set agenda and will return, whereas traveling is more daunting because it doesn’t have the same connotation that you will be coming back soon. We take trips to the store, children go on school trips, or a trip to the library. But people sometimes travel abroad, they travel because of work assignments, or someone might be unavailable because they are traveling. It sounds mysterious and undefined. So instead of traveling with kids, think of it as taking a trip with them. The truth is, to enjoy the experience you must have realistic expectations. It is a mental game, and it begins with thinking of the journey as a trip instead of traveling.

The type of trips that I am referring to are not trips to Disneyland, or trips where the itinerary is preset from a tour or guide. These types of trips can work out wonderfully, but often times they can involve a big expense, especially when you have a large family. The trips I will discuss are more the types where you go somewhere just to try to experience a different perspective than your own. These can be subtle differences related only to the difference between living in a city versus out in the country. Or it can be a much more obvious difference where you are going to a place where they speak a different language. But the experience will be designed by your personal goals for traveling.

As a parent to 4 small children, my goals have to be simple. I want to eat local food, I want to drink local coffee, and I want to try to see a bit of the “old town”. Most cities or towns have SOMETHING culinary for which they are known. When I brought my husband to Indianapolis, I wanted him to try a pork tenderloin sandwich. It is a simple but fun goal of experiencing a food or preparation of a common food that is unique to a particular area or region. With www.tripadvisor.com and other travel websites in abundance, it is easy to see the general consensus of what people appreciate in any given area.

The weather is going to be the main factor influencing how easy your trip with kids will go. As long as it is not windy and raining hard, you should be able to do pretty much whatever you set out to do. The trick is determining what those plans will be. My recommendation is to pick an area where most things can be accomplished on foot. This can be a bit more difficult to accomplish in the US than in Europe, so you may have to modify depending upon where you are, but I do think in many US cities it can be done. It is also important to accept that you are not going to get much “accomplished” each day from a productivity standpoint. This means it will be much more relaxing for everyone if you plan only 1-2 things to do a day. With children, especially young ones, the day runs the smoothest if eating times are generally respected as in their usual routine. So basically you need activities that fill only around 3 hours before a break for eating happens. There should be no shame in spending those 3 hours in a park or a plaza. Either of these can have beautiful views of the area and are a relaxing place to people watch. You may even be able to get opinions from locals in the same situation (with kids) as to child friendly places to eat, etc. But the truth is with the internet and the apps available on Smartphones today, it is quite easy to find appropriate places to go.

With 4 kids we usually stay in an apartment or house when we travel because most hotels would require us to have 2 rooms. Staying in an apartment is usually much cheaper than a hotel and it also provides the option of eating at least a few meals without the behavioral expectations and the cost of a restaurant. When traveling abroad it can also be a treat to see the inside of some of these older apartment buildings and the different ways that they are decorated or furnished. Websites such as www.airbnb.com, www.homelidays.com, or www.rentalia.com make it easy to find the perfect place for your family to stay.

One “ah-ha” moment I had occurred when I was traveling from Europe to the US with my 4 year-old daughter. We had a 5-hour layover in New Jersey after already having flown 10 hours across the Atlantic. I started feeling very stressed about how difficult this is for a 4 year old and felt like I was asking too much from her. But then it hit me that she has absolutely nothing else to do. It doesn’t really matter to a 4 year old whether she is playing in her room or playing in an airport. As long as she is fed and feels secure, she is fine. I do a lot of preparation before long trips discussing how great it will be to see our family, all the different things we will do once we are there, etc. The excitement (and a few well placed chocolate treats) can distract from the duration of the journey. It is always worth the effort to interest the children in reading books aloud, word games, and making up games such as “I spy,” “what doesn’t belong,” “animal, vegetable, or mineral,” and so forth. There is an age range from approximately 9 months until 2 and a half years old where it is AWFUL flying for more than 3-4 hours. They don´t understand what is going on and electronic devices have not sucked them under their control yet. But somehow, even during this miserable age range, you get through it.

In conclusion, as the summer months are upon us, a great way to expand your mind and to shake off those winter blues is to take a trip. Even with children, this is an achievable goal if you have a realistic mindset. Depending upon their age, children can also benefit from the experience of leaving their home. At the very least, it will make you appreciate your home more than ever upon your return.

Marissa McDonald
Jim McDonald
June 1, 2016

To Nap, or Not to Nap? That is the Question.

Many have the perception that for adults, taking a nap on a regular basis is a sure sign of old age, a lethargic personality, or just being lazy. Simply take a look at the cartoon characters Beetle Bailey, and Garfield the Cat to support that concept. But hold on a minute. Guess what Winston Churchill, Albert Einstein and Salvador Dali have in common? They were great nap takers! If we stop to think about sleep in general, and napping specifically, we will realize that humans spend roughly one-third of their life asleep, so in our evolutionary process, we have obviously found this pastime to be beneficial in bringing our mind, body, and spirit components into harmony. Far from being “unproductive” time, the hours we spend sleeping play a positive role in how successfully the other two thirds of our lives play out. Moreover, studies by NASA and other sleep researchers have reported that as little as a 10-minute power nap boosts our alertness, memory, mental and physical performances and may also reduce our risk of heart disease.

As we are piling up our ZZZ’s, we are cycling between two different stages of sleep: REM (rapid eye movement) and non-REM (non-rapid eye movement). Briefly stated, as we sleep, the body follows a repeating cyclical pattern of NREM and REM sleep occurring roughly every 90 minutes. We spend about 75% of this time in NREM sleep which is divided into 4 stages, each containing important elements in the restorative power of sleep. Our dreams occur during the shorter periods of REM sleep. A nap involves a period of time shorter than a complete cycle of the 5 stages of sleep. Power naps generally last 20-30 minutes, but can be shorter. During this time period the body does not enter into the deepest sleep, which normally occurs in stage 3 and 4 of NREM sleep. Waking during the middle of a sleep cycle may not produce a feeling of being refreshed, but produce the opposite effect. Therefore, a nap lasting under 30 minutes will avoid the feeling of grogginess in us upon waking. A 100-minute nap constitutes a full sleep cycle and may assist in creativity as well as heightened emotional and procedural memory.

Napping may produce its beneficial effects by increasing the release of the neurotransmitter, serotonin, which promotes feelings of well being, while reducing the effects of stress. Heart disease, blood pressure values, dementia risk, and immune function are all negatively affected when we are sleep-deprived, thus we may receive health benefits from our minutes spent napping. Sleep appears to be an absolute requirement for all mammals and most other animals. These requirements range from about 3 hours per day for the horse to 19 hours per day for the bat. Many reasons exist for the variation in sleep requirements ranging from the size of the animal, its eating habits, brain metabolism, etc. Most mammals sleep for short periods during the day, unlike humans who attempt to achieve all their sleep requirements in a single bout at night. This pattern appears to disagree with how we are naturally programmed. Biologically, it has been suggested that humans are programmed to receive two periods of intense sleep daily. These occur around 2-4 am and again at 1-3 pm. In many places in the world, naps are woven into the ways of everyday life to respect this natural dip in afternoon energy.

Though research has been unable to pinpoint an exact amount of sleep needed by people at different ages, the National Sleep Foundation identifies the “rule-of-thumb” amounts that experts agree upon. For adults 26-64 years of age, a recommended sleep range is 7-9 hours. For those over 65 years of age, the range is 7-8 hours.

Personal sleep trackers can provide insight into the quality of your sleep. They can record the total time spent asleep, times of restlessness or being awake, heart rates, snoring episodes, and some even claim to be able to differentiate between sleep stages. There are many questions regarding the reliability of the information from these devices, as well as a huge range in cost. However, many experts agree that any attention given to determining the level of quality sleep is a step in the right direction toward achieving wellness and better health.

Roughly 50% of people who are middle-aged and older complain of symptoms of chronic insomnia. Circadian rhythms are physical, mental and behavioral changes that roughly follow a 24-hour cycle. They have a genetic component and are produced by natural factors within the body, but are also affected by signals from the environment. Light is the main cue influencing them, and these rhythms are important in determining human sleep patterns. Melatonin is a hormone made in the pineal gland in the center of the brain that makes you sleepy. When exposed to lower levels of light, the body produces more melatonin and vice versa. Based on this observation, some tips for healthy sleep include: avoiding bright light in the evenings, and exposing yourself to sunlight in the morning. Many of us are guilty of using electronic devices just prior to bedtime. The blue light emitted by these devices significantly effects melatonin production. It is recommended to use an app to filter out this blue light from your devices. In addition, maintain your bedroom in the range of 60-67 F degrees if possible, and free from any noise that might disturb your sleep. Maintain a regular schedule of sleeping, even on the weekends.

Melatonin is the only hormone available in the U.S. without a prescription. Some individuals use it to enhance sleep as well as to reduce feelings of jet lag during global travels. As it is classified as a dietary supplement, it does not require FDA approval, nor are the manufacturers regulated. Listed doses may not be controlled nor accurate and can cause the amount of melatonin in your blood stream to rise to much higher levels than occur naturally in your body. How much to take, when to take it, and melatonin’s effectiveness, if any, for particular sleep disorders is only beginning to be understood.

Sleep is a critical component to our overall wellness. The “productive” environment that we are living in today has pushed our bodies away from some of their natural sleep patterns. In addition, our excessive use of electronics, caffeine, and high levels of stress and anxiety keep us from getting the amount of sleep our bodies need. Napping has proven positive effects for our mind, body and spirit. Some companies that are embracing this performance aid include Uber, Google, Zappos, and PricewaterhouseCoopers. Even if your company has not yet invested in a “nap pod”, listen to your body and find a place to catch a quick nap when you sense your that body needs it.

Marissa McDonald
Jim McDonald
May 29, 2016

Fighting “the Blues” with Your Sweat

As a new Spring season arrives each March, most of us are greatly relieved by the thought of leaving the winter ‘blahs’ behind. Visions of upcoming flower blossoms, the rich green shades of emerging plant life, and melodic bird-calls provide us with a sense of hope and optimism. But for millions of Americans, this scenario does not play out quite this way.

Depression is a mood disorder that produces a persistent feeling of despair and sadness, and often a loss of interest in doing normal day-to-day activities. Of the 250 million adult Americans, 8½ million suffer from major depression; another 23 million report being depressed at any given point in time. In the former case, seeking medical advice from a qualified professional is clearly the best approach. Most people with depression feel better with prescription medications and/or psychological counseling. But in looking for alternatives to taking antidepressants, which are often accompanied by significant adverse side effects, what is a person to do to relieve intense periodic feelings of sadness and “the blues?”

Fortunately, there is a relatively simple and inexpensive solution that works for many. Countless research studies have reported that regular exercise can help with the symptoms of depression. And this doesn’t mean you must run marathons or scale Mt. Everest to receive such a benefit. An assortment of different physical activities have been shown useful in this regard. These may include running, walking, cycling, yoga, tai chi, health club workouts, and various outdoor activities such as gardening. Moreover, this kind of physical activity may not only suppress feelings of sadness, but also prevent feelings of anxiety and depression from returning. People who are physically active consistently report a greater sense of excitement and enthusiasm about life than do the less active individuals. Regardless of your age and fitness level, research studies indicate that exercising regularly provides significant mental health benefits. An added bonus seems to be a general reduction in stress and better sleep habits as well.

Thus it is widely accepted that in addition to improving our general health, regular physical activity can also help us improve our mood and become happier. And who doesn’t want that? In fact, exercise may be as effective or more so as taking antidepressant medications for treating depression. One wonders how this process might work. Research suggests that the release of “feel-good” chemicals in the brain such as endorphins and dopamine is promoted by exercise. Increases in their levels within the human body produce feelings of well-being and pleasure. These same chemicals may be deficient in the brains of those fighting depression.

The question often comes up, “How much exercise is enough to receive these benefits?” More research is required to get a definitive answer, but it is generally suggested that 30 plus minutes a day for 3-5 days a week is beneficial, but that less may also be helpful. Even 10-minute periods of physical activity may work through the brain to improve your mood.

The biggest snag in all this is probably getting started and maintaining the motivation to continue. Those with depression often lack motivation in many aspects of their lives. Recovery from depression requires action, but taking action when you are depressed is very difficult. Getting out of your chair to exercise at a time like this may feel like the very last thing you want to do. But any long-term behavioral change requires high levels of motivation and persistence, whether the goal relates to eating habits, patterns of physical activity, or forming a new mental outlook. Our book, Mind-Body-Spirit Connections, contains portions of several chapters devoted to how to successfully change from making unhealthy lifestyle choices to selecting healthy ones. Several major points are summarized below on how to begin and utilize exercise to help with mild depression:

1. Start small. Strive to set a single, small goal, such as “I am going to begin taking regular walks 4 days a week.”
2. Set a specific time when this will take place. For example “I will walk before breakfast on two weekdays and two weekend days regardless of how I feel.”
3. Reward yourself for your successes. For example, treat yourself to a movie, concert, new book, etc after each successful week of meeting your goal.
4. Be accountable to someone. Describe to a friend or family member precisely what your goal is and faithfully report to them how you are progressing.
5. Make it a social event. Try to recruit neighbors, co-workers, friends or family members to join you for your particular physical activity.
6. Choose a physical activity that is fun for you. You may even be able to make it a “play” activity if you use a pedometer or Fitbit to monitor your activity each day.
7. Make it a permanent habit, and take it one day at a time. Never allow yourself to debate whether to exercise or not on a scheduled day. Each day when you arise, make the planned physical activity session an unequivocal habit just like brushing your teeth.
8. Consider exercising out of doors. There is something uplifting and exhilarating about observing nature while in the midst of physical activity.

Many individuals have successfully used exercise as a means to alleviate feelings of sadness and depression. We should all remember that each morning we are born again; what we do today is what matters most!

Jim McDonald
Marissa McDonald
May 22, 2016

Lifestyle Differences in Catalunya

Following a two-week hiatus related to travel, we (Jim and daughter, Marissa) are resuming our blog postings. As mentioned in our very first post, I (Marissa) have been living with my family in Spain and Andorra for the past 10 years. Andorra is a tiny country of some 73,000 inhabitants nestled in the Pyrenees Mountains between France and Spain. It has long enjoyed one of the world’s longest life expectancies. It thus seems appropriate for me to look closely at some of my personal experiences while living in the Catalan region of Spain and in the Pyrenees, and to look for behaviors and attitudes that may be related to our health and the quality of life.

As in any society, certain cultural and regional particularities exist related both to food selections and the eating behaviors associated with them. When living in a different continent, these differences become quite eye opening and often humorous. Living abroad also helps you become aware of your own habits and traditions derived from your family, regional influences and culture; often you are unaware of these intrinsic expectations until they are challenged by a contrasting style. The reasoning behind these different choices and behavioral patterns is often tied to various degrees to the “mind-body-spirit” values of the specific culture. So here is what a young woman from Indiana learned about how “it” is done when living in Catalan country.

1. For breakfast you are allowed to consume chocolate bars. Not Snickers or Twix, but plain dark, milk or white chocolate bars. You may eat a few squares, and place them inside a croissant or a roll, or you can simply pop them in your mouth and have them melt there while sipping warm milk or coffee. You don’t have to have accomplished ANYTHING to deserve the chocolate, nor do you have to sneak it. The reward system philosophy is different here, especially when it comes to chocolate. Eat it when you want it and enjoy it. No guilt is required!
2. Generally, after completing breakfast, THEN you have your coffee. Refer to point number 1 for an exception to the rule of drinking it by itself. You can have a bit of chocolate while simultaneously savoring the coffee. I have adapted well to this ritual for two main reasons. First, I never liked coffee before I moved here, and second, it brings a consciousness to the morning routine. Having to get 4 little kids off to school produces kind of a blur as to what is going on. But for the 5 minutes while I am drinking my coffee, I try to be present in the moment and enjoy it.
3. Lunch is our big meal of the day. During weekdays, it is generally served anywhere between 1:30 and 3:00 pm, and even later on weekends. Our children have a two-hour break from school then, and my husband usually come home for lunch. This kind of schedule means that kids typically get a small snack in the morning, and another after school at 5 pm. In the winter, our dinner time begins around 8 pm, but in the summer it may be as late as 9:30 pm. The efficiency of this schedule is questionable, and if Spain wants to compete in global markets, perhaps it needs to be modified. But this represents the spiritual side of the culture, and indicates the people’s values. In my opinion, efficiency is not an intrinsic value here. It may drive me crazy at times, but it sure is nice spending two hours at lunch with my family.
4. Lunch is always served as a first course followed by a second course, and then dessert. The concept of having one plate with both courses served on it is very confusing for a typical Catalan. The first traditional American Thanksgiving meal I served to my Catalan family consisted of a plate piled with turkey, green beans, potatoes, and cranberry sauce … and it paralyzed them. They had no idea how or where to begin eating. In considering efficiency factors, it makes sense to me to dirty a single plate with all the food, and get on with things. But when it comes to food, efficiency is not really the priority here. Presentation, textures, flavors, and tradition have much greater value.
5. Butter is nowhere to be found here, but olive oil is everywhere and is a critical staple. It is used to fry foods, to coat pans, to add to toast or salads, and is even used in baking. Since we have moved closer to France, there are some exceptions, but those exist primarily in baking. Traditional Catalan cooking revolves around the use of olive oil. Our previous posting has discussed some of the health benefits of olive use consumption.
6. Honey is not only used as a sweetener, but is considered medicinal as well. Warm milk with a tablespoon of honey is the typical treatment for a cough. There is research supporting this approach as being equally or more effective than the use of cough syrup. In addition, there are none of the potential dangers associated with ingestion of cough syrups.
7. Flat leafed parsley is provided free at fruit and vegetable stands as well as at many supermarkets. When you have your produce weighed, you can ask for parsley, and they hand you a bag full of it. This is quite beneficial since the vast majority of Catalan recipes call for parsley. It is far more than a garnish, and is cherished for finalizing the presentation of a plate. Flat leafed parsley is rich in vitamin K, A, and C and possesses antioxidant effects.
8. Attitudes toward alcohol appear more liberal here. It is not uncommon to see someone having a small glass of wine or a beer with breakfast. At lunch, a glass of house wine is included in the “menu of the day.” After dinner you could have a “digestive” which may be sweet or herbal alcohol. House wine or a beer at a restaurant frequently costs less than a soda. The legal drinking age is 18, but families often allow children younger than that to consume an alcoholic beverage in a family setting. It is difficult to determine whether this liberal attitude leads to more responsible drinking or not, but there is clearly evidence that drinking alcohol only in moderation is the healthiest choice no matter on which continent you live.
9. Fresh fish is delivered on Tuesdays and Thursdays and the entire fish counter is closed on Mondays. The specific days vary according to which city you live in, but you need to plan accordingly.
10. This final point is not a culinary recommendation or behavior, but it is Catalan preventive medicine. Scarves are a critical wardrobe requirement in this part of the world. The belief here is that if cold air or a breeze touches the bare skin of your neck, you will get sick. Never mind the role of the virus, or bacteria, the culpable party is nearly always that you forgot to wear a scarf and that some unexpected breeze attacked. When my 86-year old neighbor catches me leaving our building with my jacket unzipped even slightly and without a scarf, she shakes her head and reminds me that I am living dangerously.

In several past postings and in our book, we have identified the health benefits of eating the Mediterranean Diet with emphasis upon the intake of olive oil, fruits and vegetables, fish, and alcohol in moderation. However, we must remember that eating this diet does not occur in a vacuum, but includes the customs of how and when the foods are consumed as well. One must wonder whether simply replicating the food items of one culture will provide the same mind, body, and spirit benefits in a different culture, or is it perhaps more complicated than it first might appear.

Marissa McDonald
Jim McDonald
May 15, 2016

A Prescription for Health: Hob-Nob, Mingle, Fraternize

Note: Because of travel opportunities, the next blog post will not appear until Sunday, May 15.

We’ve all heard it a million times. To stay healthy, you must exercise and eat your fruits and vegetables each day. Perhaps there is an additional, equally important piece of advice to heed for not just a longer life, but a happier one as well. It is recommended that we establish strong social connections and have meaningful friendships in our lives. The word “social” derives from the Latin word “socii” meaning allies. Yes, this seems like something we can do. Certainly we can all benefit from allies on this trek through life, and socializing is a lot more fun than eating spinach!

As the celebration of Mother’s Day approaches, we are reminded of how important the bond is that exists between a mother and her child. This strong connection lays the groundwork for the child’s future social, emotional and cognitive development. A recent study demonstrated an increase in size of the hippocampus in the brain of children whose mothers focused on nurture and support during early childhood. The hippocampus primarily deals with the formation of long-term memories, and the increased size was interpreted to equate to possession of a greater capacity for learning and memory throughout life for these children. While there can be objections to this interpretation, from anecdotal experience, it does seem that those who do have a good relationship with their mothers do tend to have a happiness advantage. Not to put more pressure on mothers, but this is an example of how important our social connections are to our growth and development.

Perhaps we have been a little slow in recognizing the importance of social connections in general in our lives and their relationship to our health, happiness and well-being. Close, secure and supportive relationships with our husband, wife, partner, relatives or friends are quite important for our overall health. Multiple studies indicate that both the quantity and the quality of our social relationships affect our mental and physical health, as well as our health behaviors and our mortality risk. Having a network of social connections or high levels of social support appears to increase our immunity to infection, lowers our risk of heart disease and reduces mental decline as we age.

In a study of the health benefits of social relationships, published in early 2016, researchers reported that social ties and increased contact with family and friends are associated with a lower risk of death in young women with breast cancer. Another study presented a similar conclusion with respect to surviving heart surgery. What’s more, a 2010 meta-analysis of 148 other studies showed that social connection doesn’t just help us survive health problems; the lack of it may cause them.

Loneliness may be defined as the quality of lacking friends or companions. Those who report high levels of loneliness often have common characteristics: they live alone, have few interactions with family and friends, and are unhappy with their lives. Loneliness has been associated with reduced immunity, perhaps due to the chronic stress of being without allies. There is a higher risk of developing cardiovascular disease, obesity, alcoholism, and depression. We appear to be a social species and do not fare well when we unwillingly live solitary lives.

The word “unwillingly” is deliberately chosen because what about those of us who are introverts? Introverts often take pleasure in solitary activities such as reading, writing, using computers, hiking and fishing. But this is not to say that introverts lead a solitary life. In the same way that you try different fruits and vegetables to achieve the benefits of a healthy diet, there are many options to fill the recommended daily “socialization” requirement. Introverts and extroverts will make different choices and clearly it is the quality of our relationships that are the most important.

Sometimes unfortunate occurrences lead to those characteristics that we previously identified as causing loneliness. Living alone due to the loss of a spouse through death or divorce. Having few interactions with family due to distances or in my case (Marissa) language barriers. There are solutions when you choose to look for them. Retirement “villages” are an incredible way to solve the problem of a loss of a partner for the older population. They offer dozens of ways to socialize through their community. Churches also often offer many social opportunities. The internet has opened doors to social connections that a decade ago were nearly impossible to access. There are book clubs, blogs, and numerous ways to find people who have similar interests to your own. On a most basic level, connecting with your neighbors helps to form a sense of community and can be an important security alliance for all parties.

So get out there and hob-nob, mingle and fraternize! Or in the case of an introvert, make sure you do enough to maintain your social alliances. The “recommended daily allowance” of social interactions has not yet been set. But maybe it is just as important as getting those 5 servings of fruits and vegetables a day!

Marissa McDonald
Jim McDonald
April 24, 2016

The Gift of Life

Many believe that to develop spiritually, we must embrace and strengthen the concept of giving to others. In other words, striving to change someone else’s reality in a positive way. And the benefactor also receives a reward of happiness. An old Chinese proverb states:

If you want happiness for an hour – take a nap.
If you want happiness for a day – go fishing.
If you want happiness for a year – inherit a fortune.
If you want happiness for a lifetime – help someone else.

What better example of helping another person might there be than being an organ donor? Two types of organ donations exist: from a living donor or from a deceased donor. Our blog post today focuses primarily on deceased organ donations. There are more than 100,000 people currently waiting for a transplant organ in the U.S. Sadly, about 22 of them die each day while waiting for their organ. The reason? The critical shortage of such organs, particularly kidneys.

There are two main methods for determining voluntary consent to be an organ donor: “opt in” (only those who have given explicit consent are donors) and “opt out” (anyone who has not refused is a donor). The United States utilizes an opt-in consent for organ donation, which reduces the practical availability of organs for those in need. Though we may talk about the desirability of doing a benevolent act, our lives are often so hectic and busy that we frequently wind up doing nothing. But in the case of organ donations, doing nothing literally can become a death sentence for those in dire need. In contrast, Spain currently has the highest organ donation rate in the world. The Spanish introduced an opt-out consent for organ donation in 1979. The understanding behind opt-out consent is that the majority of people support organ donation, and to opt-out they must perform an action: to unregister themselves if they don’t want the process to occur.

The gift of tissues from one deceased donor can be even more productive, and may save up to 8 lives and enhance more than 100. This type of donation may involve the cornea, the sclera (white of the eye), heart valves, skin, bones, tendons and even amniotic tissue. Up to 95% of all deaths are eligible to donate tissues, whereas only 5% of deaths are eligible to donate organs.

Brain donations are another possibility to help medical science, and a number of high-profile American athletes have recently publicized their desire to donate their brains for research into Chronic Traumatic Encephalopathy (CTE). The latter is a progressive degenerative disease sometimes found in individuals who have suffered repetitive brain trauma, such as is currently highly publicized among National Football League players.

Whole body donation connects people who wish to donate their body to science with medical researchers and educators who rely on donors to further their research. It is estimated that such programs provide up to 15,000 dead bodies annually to the nation’s medical schools.

Let´s return to the opt-out consent for organ donation in Spain that went into effect in 1979. For the first 10 years following the enactment of this law, it had little effect on donation rates. Apparently the presumed consent policy was never strictly applied in practice; relatives always had the final say, and they often said “no.” So what happened in 1989 when organ donation rates in Spain finally began to rise? A connection was made that previously had been overlooked. Brain dead donors comprise 95% of the donations in Spain and these people are usually being cared for in the ICU. The person fundamentally most capable of influencing the process of coordinating a successful organ donation would be a clinician primarily located in the ICU, who would be able to appropriately promote the idea of organ donation as a part of end-of-life care to not only the team working on the unit, but to the family of the patient.

The National Transplant Organization (ONT) was established in 1989 and introduced Transplant Donor Coordinators (TDCs) of whom the majority were ICU physicians. Only with the establishment of ONT and the introduction of TDCs did donation rates begin to rise. This was attributed to the skill of the well-trained transplant coordinators who approachd the grieving families. It is notable that the consent rates for foreign nationals living in Spain (coming from other parts of Europe, Latin-America, Asia or Africa) match those of the native population.

The original goal of this topic was not to analyze the importance of a mind, body, spirit connection, but the process of organ donation in Spain does just that. It requires the “mind” to evaluate the opportunity and to make a choice to participate or not. Many different methods and levels of participation in this process have been outlined above. On a basic scientific level we are talking about the mechanical process of removing something from one “body” to place it into another. And how interesting, that even in a situation where the choice was essentially eliminated for a passive person, (an opt-out consent) it wasn’t until there was a “spiritual” connection with grieving families and the ICU team that a change was seen in the outcome. When progress toward desirable outcomes is slow in coming, it is always a good idea to evaluate the congruency of the mind, body, spirit connection. If one of these connections is missing, the pathway to success is often unattainable or achievable only for a fleeting moment.

Here are a few links to get you started if you are interested in organ, tissue or whole body donation.

http://www.organdonor.gov/
https://www.unos.org/
http://www.sciencecare.com/

Marissa McDonald
Jim McDonald
April 17, 2016