Mary-Jo Murphy, MS, RN, CDE, certified diabetes educator
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Wired 

10/25/2012

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art by Craig Rohlfing

A few months ago, my son and his girlfriend invited me to go bowling. I hadn’t been in a bowling alley for several decades, and even then I wasn’t any good. My response was to panic. I’d look stupid and clumsy. I’d throw my back out.

“Oh come on, Mom. The ball doesn’t weigh any more than our cat, and if you hate it you can watch.”

Out of excuses, I went. My fears were unfounded. No one noticed me, much less laughed at my attempts. The ball was more manageable than Felicity, my flighty feline. After a ton of gutter balls, I had burned 175 calories and discovered some new muscle groups, the most important ones being in my face. I haven’t laughed that hard in a long time.

Endorphins, the feel-good hormones, reward us when we do what our body is designed to do, MOVE. We are hardwired as humans to seek pleasure and avoid pain. I think other wires are also hooked to our psych, the obsess and avoid ones.

When you were a teenager and your parents said you couldn’t do something, didn’t that suddenly became the most intriguing thing on your to-do list? Most of us haven’t changed. “When I even think about starting a diet,” a friend told me,  “I can’t stop eating.”

I understand. A few months ago, my doctor scheduled me for a test, which required  dietary restrictions. For some chocolate is an Essential Food Group. This is not true for me, or at least it wasn’t. However, the night before the test I received a gift, a large piece of chocolate. Chocolate has caffeine, and on the list of don’t-even-think-about-it items were foods containing the lovely stimulant. I brought the chocolate bar home, hid it and tried not to think about it.

The day after the test was completed, I was on a mission. Devour that chocolate bar. The taste was amazing! Interestingly, once the thing was consumed and the restriction gone, so was my uncharacteristic focus.

When we tell ourselves we can’t do something, the thing we have eliminated becomes a painful pre-occupation.

Recently another friend reported that she had read something that motivated her to try to decrease her calorie intake by 30%. She awakened one morning with this daunting task as her goal. By noon her sense of deprivation had reached epic proportions. She too couldn’t stop eating.

Similarly, when we tell ourselves we have to do something everyday, we soon avoid the activity. Few people succeed with the change-your-body-in-few-short-weeks exercise program, but the concept plays into our need for silver bullets and quick fixes. Small things you begin today will yield abundant changes months from now.

“Motivation follows action; it does not precede it,” says Rita Milios, LCSW in her article, Demystifying Motivation in Diabetes Self-Management, March/ April 2010. Milios suggests we break our goals into small steps. If we resist those, she asks us to consider breaking them down even further. At some point we’ll find something we’re willing to do. Our willingness to do small things consistently is the truest measure of your potential to reach a goal, she says.

Though it would be good to get 150-300 minutes of exercise each week, 5-10 minutes a day is a positive step. Five pats on the back burn more calories than ten minutes of beating yourself up. The more you follow through with your commitments, the more positively charged your emotionally energy becomes, and the more motivated you’ll be to stick with it.

Habits start with action, not endless planning. If you are still resisting, I suggest you take this small step, plan to be spontaneous tomorrow.  


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Birds, Bees and Cholesterol

10/16/2012

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Recently, I accompanied a friend to her doctor’s appointment. Over a year ago, she had been diagnosed with diabetes, my specialty. She is what Dr. Jerome Groopman and Dr. Pamela Hartzband refer to in their book Your Medical Mind, as a doubter. Over the past year she reluctantly embraced treatment. With medication and life-style changes she has lost 30 pounds and returned her Hbg A1C (a blood test that predicts complications related diabetes) to well below recommended levels. She’s a success story. So why was I not surprised when she declined to receive the flu and pneumonia vaccine that her doctor recommended?

Because, as a doubter, she’s also a profound skeptic. She questions how much benefit a therapy really offers and what could be the harmful consequences.

I’m what the book calls a believer. I approach my options with a sense that there is a successful solution for my problem somewhere.

The authors also define people as maximalists and minimalists. A believer can shun high-tech intervention and have a strong belief in the healing power of nature. Or a believer can embrace the latest technology modern medicine has to offer. If the person is a maximalist, they believe that more treatment is the best approach and that doing less is shortsighted. A minimalist will embrace only such treatments as are absolutely necessary. Doubters are usually minimalists. That’s my friend. We become doubters because of various life experiences – we saw someone suffer from  too much care, the wrong care or care that feel short of expectations.

Groopman and Hartzband tell us that another powerful influence on our thinking is the “focusing illusion.” When considering a decision about a medical treatment we try to focus on the future and a particular aspect of our life that would be negatively affected by the proposed treatment. What we might lose becomes the main factor in our decision-making. The book validates the difficulty many of us face in the health care arena – our doctors’ recommendations, dissenting expert opinions, confusing statistics, sensational media reports, our friends’ advice, Internet claims, and drug company ads. Conflicting information pulls us back and forth.

That’s how we make health decisions for ourselves but what about for our children? Two hot topics in the news caught my attention recently: cholesterol screening for children and the debate raging over the Center For Disease Control’s recommendation for boys 11 and 12 to receive the HPV vaccine. Both decisions force a parent to look into the future, a future that they may not even live to be part of, but which their decision will undoubtedly affect.

In one case, the testing for cholesterol, the parent can find out if their child is at risk for heart disease. Months ago on CBS news, Dr. Holly Phillips stated that 12.5 million kids in our country are obese, but not all have high cholesterol. The testing will give parents a heads up, so that they can intervene with healthful diets and exercise before changes to the blood vessels start occurring. To find out your child may have a higher risk of blood vessel disease may be disturbing, but it’s a warning that could lead to positive changes that alter the future. As I said to my friend when she was having her blood drawn  to see how her diabetes was doing, “It’s information. It’s not a judgment; it’s just information.”

Driving on the freeway the other day I saw a billboard that read: “He’s off to college. It’s too late to talk about alcohol.” How true! We parents have our chance to speak and be listened to before our kids hit puberty. After that, we’re out; it’s their peers.

So what in our medical mind allows us to process the yucky subject of a vaccine to prevent a STD? How do you look into the eyes of your prepubescent son or daughter and explain that they, as well as over 50% their friends could someday be infected with a virus that causes: oral cancer, cervical cancer, penile cancer, anal cancer and oral cancer? How do you explain the need for this vaccine when 11-year-old boys think that girls have “cooties” and girls their age think that boys are “gross.”?

How about telling them that the vaccine they are receiving prevents cancer caused by a virus? Now, you may have to explain what cancer is, maybe even what a virus is. I suppose it’s possible that an 11 year old will press for details as to how the virus is transmitted. Good. In that case you, and not their peers, get to be the one to explain. Remember though, it’s always good to start simple and only answer the question asked.

I’m reminded of the story of a child who inquired, “Mom, where did I come from?” Figuring the time had come, she took a deep breath and explained the birds and bees in great detail. The kid looked confused. “No, I mean; one of my friends said he was from Chicago. I was just wondering where I came from.”


http://www.latimes.com/health/boostershots/la-heb-promiscuity-hpv-vaccine-20121015,0,5783319.story?track=rss&utm_source=dlvr.it&utm_medium=twitter&dlvrit=53001

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Stayin' Alive

10/13/2012

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Have you ever felt that sense of foreboding or uneasiness that surfaces despite the busyness of the day? Something is nagging at you. You push it away; stifle the thoughts that lead up to it, but the feeling that something bad is happening creeps into your dreams. You have the sense that you have forgotten something. What is it? And then you remember…

In Ben Sherwood’s, The Survivors Club, we learn that lucky people listen to these hunches. They don’t stay in denial. They make good decisions without really knowing why. Unlucky people make unsuccessful decisions and trust the wrong people. Lucky people persevere in the face of failure and have an uncanny knack for making their wishes come true. Lucky people have an ability to turn bad luck into good fortune.

So now you’ve remembered that you have this weird new symptom or feeling that you’ve been trying to ignore. But will you do anything, or will you ride our your luck?

Richard Wiseman, a professor at the University of Hertfordshire in England writes, “Luck is not a magical ability or a gift from the gods, instead, it’s a state of mind, a way of thinking and behaving.” He believes that only 10% of life is purely random. The remaining 90% is “actually defined by the way you think.”

Lucky people constantly happen upon chance opportunities. “Being in the right place at the right time is actually about being in the right state of mind.” They seize upon openings that other people miss.

In 1994 a man named Paul Barney survived the sinking of a ferry, the Estonia. In a Force 9 gale, the vessel hit an island in the Finnish Archipelago and went down, killing 852 people. Was there something extraordinary about Mr. Barney? How much of his ability to survive was luck?

John Leach in his book Survival Psychology speaks of the 10-80-10 theory. He says the top 10% will handle a crisis in a relatively calm and rational state of mind. This group pulls themselves together quickly. They assess the situation clearly and make decisions that are sharp and focused. They develop priorities, make plans and take appropriate action. They refuse to let themselves be overwhelmed. Psychologists call this “splitting.” It’s common among people who keep cool under great stress.

Most of us fall into the 80% group. We become stunned and bewildered. We have trouble thinking. We behave in a reflexive mechanical matter. We feel lethargic and numb, sweat; we feel sick. We don’t see what’s around us. We become like statues. The good news is that most of us recover from our brain lock and figure out what to do.

The last 10% do all the wrong things. The freak out and can’t pull themselves together. They actually become a danger to others.

How do you see yourself? Are you lucky or unlucky? If you fell down the stairs and broke you ankle, would you see the luck in the injury being only your ankle and not your neck? Or would you feel as if you’ve been singled out for bad things?

I can’t speak with authority about the scenarios described in The Survivors Club. Unresponsive parachutes, plane crashes and mountain lion attacks are thankfully not on my list of things about which I can give advice. But I have spent time with other types of survivors, people who picked up cancer early because they had regular mammograms or colonoscopies, people who survived car crashes because they wore seatbelts, stroke and heart attack sufferers who got to the hospital in time, those who discovered their diabetes before complications set in.

Do these people feel lucky? They have stories to tell about “catching it early,” and responding. Sure, maybe they became statuesque for a short time, but they listened to the nagging uneasiness that was pushing them to respond. I think that ability to listen to your body puts you in the Survivors Club.                       
You may never be in a sinking ferry or a plane crash, but thinking like the top 10% could save or prolong your life. Whether you worry that your excessive thirst might mean that you have diabetes, or wonder what that chronic indigestion can be, action is always better than watching your luck unfold from the sidelines.

When we decide to take control, to address a concern, we may feel and initial panic, we may even feel we are overreacting. It’s not that bad, we think. We tell ourselves, I’ll put up with it, put it off another day. Maybe the doctor will think I’m a hypochondriac.           

Wouldn’t that be the best news, to find that your concerns are all in your head? But if they aren’t, if something is really happening that you need to address, wouldn’t it be great to be counted in the top 10%, to be a survivor?

If you’ve been putting off or procrastinating, I’m suggesting that you consider fall, house cleaning. Start with your garage. Do your windows too. Give some old clothes away. And when you finally feel energized and engaged, consider taking on one of those health related things on your “to do” list. Pick up the phone and make that appointment. You might just be a survivor.

 

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