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No Safe Place in a Storm

Tonight my heart is heavy.

This has been such a traumatic week. Last Thursday, my husband, two dogs, and I packed up and left our home in Naples, FL. We didn’t plan to go. We planned to hunker down and ride out the category 5 storm that Irma was at the time. For days we watched Irma’s progress. On Wednesday night, after talking with my daughter, who was so worried about her mother’s safety, we threw as much as we could into our car and headed north to Atlanta.

The trip was horrendous. We spent 20-hours in bumper-to-bumper traffic trying to get somewhere that usually takes 8. Others took much longer. Cars broke down along the side of the road, without fuel. Evacuees lined up around the block, waiting for gas stations to open once they received gas. Sadly, these stations had to turn people away who had waited for hours, after they again ran out of fuel.

My older cousin, whose husband was in the hospital following a stroke, was told to leave his side and find shelter. She started the long trip through Florida trying to find a non-existent hotel to stay for the night. I was on the phone frantically trying to help her find a room, a gas station with fuel, or even a shelter that allowed pets.

Many of our friends, who were veterans at dealing with hurricanes, stayed in their homes. Despite their prior experience, they were frightened for their lives. We were frightened for their lives too. And these friends and family, who had remained in their homes or who were still on the road desperately trying to get out of harms way, were solidly on our minds and in our hearts as we watched Irma close in.

Underlying all of this was the frightening realization that we could lose everything.

The evacuees that we encountered in gas stations and in the hotel were so supportive. For a few days, we forgot about the division and dysfunction in our government and the anger in our country. We connected with each other on a personal level because of the immediate threat and our common fears. Thankfully, the people that we met in Atlanta could not have been kinder as they welcomed us with open arms and offered us shelter and food.

We were struck by the irony that while we were running from something so frightening and other states opened their hearts to us, there are many people fleeing counties where wars are raging, and we are turning them away. They and their families are losing everything they have, but must also risk losing their lives by being forced to stay in a dangerous country. Young people who were brought here as children, and have lived in this country for most of their lives, are afraid they will be forcefully sent to live somewhere else that is not their home.

I cannot imagine how I would’ve felt had we reached the Florida/Georgia line and been told we were not welcome. That we had to turn back to the storm. I realize that this traumatic, yet relatively short-lived, experience is something others endure for years, and my heart breaks for them.

Thankfully for us, Hurricane Irma spared southwest Florida the complete devastation promised by a Category 5 hurricane, and was downgraded. With a slight change in her path, Irma spared us of the life threatening storm surge we were told to expect. That doesn’t mean that we weren’t affected, displaced from our homes due to damage and loss of power and out of work. Many people in smaller communities of SW Florida will not be able to return to their homes for some time and don’t have a comfortable place to stay while they wait. We are going through a lot of pain and suffering right now. But in comparison to what could have been, we were lucky this time. This is tragically something that many people in Puerto Rico, Cuba, St. Maartin, smaller islands in the Caribbean, and Houston (completely devastated by Hurricane Harvey weeks before) cannot say.

I don’t know what is in our future. I know that right now we are okay, and that we are alive, and I am forever grateful for that. We have a relatively comfortable place to stay while we are displaced from our home. This was not Florida’s first rodeo, and although it will take time, we will rebuild our homes and our lives.

But tonight, I lay awake thinking about how life can change in the blink of an eye; how a comfortable life can suddenly be upended and, through no fault of our own, we can lose everything. I think about how this is happening on a greater scale to many families in our country that were hit harder by the storms and to many people throughout our world whose lives are impacted by storm, war, famine, and disease. And maybe even more humbling, I think about how many people don’t have a safe place to turn in their storm.

Tonight, my heart is heavy, and I will allow myself to sit with this heaviness. I know that this is the uncomfortable part of healing. Tomorrow, I will find the energy to do something constructive about it.

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How Team Mentality is Actually Hurting our Country

I grew up in a small town outside of Pittsburgh. In rural America, football was a big part of growing up. By the time we were six years old, little boys were playing on the midget league and little girls were cheering from the sidelines. From a young age, we developed a strong sense of pride in our team.

Every Friday night we huddled together on the cold, hard bleachers. We held a cup of watered down hot chocolate in our hands, as we watched our team compete. The band opened the game with the Star Spangled Banner, and we proudly held our hands to our hearts. We cheered as our team rushed onto the field. We stayed until the last play and our throats were hoarse from yelling so loudly. Sunday’s were for God and for the Steelers. We rushed home from church and changed into our black and gold jerseys. We waved our Terrible Towels while we watched our team play.

We were not fans. We were part of the team. The players and the coaches became our heroes. There were times that we turned our heads when our heroes acted as if rules did not apply to them. We turned our heads when they hurt others. We often put them on pedestals and we failed to hold them accountable for their actions. Because we believed that regardless of how unfair the world seemed, through these heroes, we would ultimately win.

Athletes don’t have to think about what is best for the league. They don’t think about what is best for the country. They only have to think about what is best for their team, because football is a game, and in a game you win or lose.

This team mentality has taken over our government, but unfortunately, not in a good way. Rather than working together, as a team, for the good of our country, our team has fractured. In a poll by Pew, just before Donald Trump’s inauguration, 86% described the country as more politically divided than ever. And even more importantly, 40% expect the country to be AS DIVIDED in five years; 31% believe that our country will be MORE DIVIDED. Republicans and Democrats alike, maintain this divide by the choices we make. We choose to live in different areas of the country. We choose to socialize with people who think like we do. We even choose to watch different news sources that support what we already “know”. And as long as we continue to make these choices, it is unlikely that we will move closer together.

This division is especially clear when we look at the behavior of our elected officials. They chose to work only with members of their own party, and lately act as if the other party are villains, rather than members of the same country. In one recent example, after months of working on a bill to repeal the Affordable Care Act (ACA), finally, Congress is working on a bipartisan bill. Why did it take that long for them to work together? You really have to wonder: Is there a benefit to those in power in keeping our country divided?

Imagine what would happen if players on the same football team stopped working together. If the Center decided to score the point himself; If the offensive lineman decided that he did not want to get hurt and stopped protecting his teammates. If each player stopped working towards the collective goals of the team, and started working towards their own goals, what would happen to that team? How long would that team survive?

Because here is the thing we keep forgetting: we are all members of the same team. We are the team of the United States of America. If we don’t put our disagreements aside and try to bridge the gap that divides us, what will happen to the team we call America?

I wish that I knew the answer to this existential problem that we face. But this problem is so much larger than I am. But there are a few things that each of us can do to move our country toward unity, and away from division.

We need to talk to other members of our team who we may not agree with

We need to talk to them with the goal of understanding, rather than the goal of defending our position. When it comes down to it, we all have the same basic needs for safety and security. We just believe there are different ways to meet those needs. If when we talk we focus on our COMMON NEEDS, rather than continuing to focus on the DIFFERENT WAYS that we think we should address those needs, we might actually start a productive dialogue. We need to clearly identify those needs and keep them in mind as we try to find mutually acceptable solutions.

Secondly, we need to be open to hearing things that might make us uncomfortable

It doesn’t matter which side you are on, we all have biases. These biases are come from our own personal experiences. Not everyone has had the same experiences in life, but that doesn’t make their experiences any less real or even less painful. Ask them about the experiences and then really listen to them. You might find that once you get to know them, you understand them a little more. You might even like them.

Unfortunately, when we hear things that go against our current beliefs or biases, it feels uncomfortable, so we turn away from people. We also gravitate towards reading things that support our current views to avoid this discomfort. But learning is uncomfortable and discomfort is a necessary part of growth. So, talk to other people. If you normally watch Fox News, read the New York Times. If you normally watch MSNBC, read the Wall Street Journal. Work through that discomfort.

Don’t get me wrong. There are some things that are happening right now that are totally unacceptable. For these things, there should be no compromise. But we are better served by strongly attacking the ISSUES (ex., racism or misogyny) rather than the people (ex. calling all people who voted for Trump racists or misogynists). When we start labeling, we stop seeing or learning.

Lastly, we need to find the courage to hold our leaders accountable

After each game, coaches and the players generally sit together to watch the film from the night before. Truly great leaders don’t blame the other team for their teams mistakes. They don’t point fingers or harass each player for every little play that went bad. However, they do expect each member of the team, including themselves, to take personal responsibility for the way they played. They look at their strengths and their weaknesses to develop a game plan for the future.

Unfortunately, we don’t seem to have that great leader(s). Many of those we’ve elected to office appear to have lost touch with the needs of the people. They appear more concerned with the needs of their large donors (i.e., insurance and pharmaceutical companies, Wall Street, and the NRA, to name a few). And for those that argue that Donald Trump is an outsider who will bring about change, he does not seem to have the capacity to self-reflect or to be part of a team. We the people need to let our representative know that we expect them to work together for us. Make calls. Send emails. Attend town halls. Vote them out.

Yes, everything that I suggest involves compromise. While compromise means that we won’t get everything we want, it also means that we will get many of the things we do. (I understand that there are a few issues that can be compromised). But ask yourself this: is the way we have been functioning for the past several years working? We get our way for a few years until new politicians are elected, and then it feels as if we lose everything we fought for. Unless we enjoy living as if we are riding on a pendulum, clutching on for dear life, swinging from the left and then the right, compromise has to be part of the conversation. It is for the good of the team.

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Mindfulness Meditation and Focused Training

Mindfulness meditation is the practice of paying attention mindfully. As Jon Kabat-Zinn describes:  Paying attention on purpose, in the present moment, and non-judgmentally. 

The ability to focus can be learned! Meditation does not have to involve a major time commitment. If you are new to meditation, or if you have limited time, you might want to start with a very simple focused meditation. Even practicing this simple meditation 5 to 10 minutes a day, has been found to have very positive effects on a persons ability to handle stress, their immune system functioning, and their overall health.

Find a quiet and comfortable place to sit. Dim the lights in the room. Turn off your cell phone and other technology that may interrupt your practice. Make sure that the room is at a comfortable temperature, and if not, cover yourself with a throw.

Identify the length of time that you want to practice. In the beginning, this may only be five or ten minutes. As you increase your ability to focus, you may want to challenge yourself with longer sessions. However, it is important to set a timer so that you do not have to watch the clock.

Sit comfortably in your chair with both feet solidly on the ground. Try to keep your back straight and lay your hands at your side or fold them together in your lap. Or, alternatively, lie on the ground.

Start to notice that you are breathing. Become aware of the sensations of breathing. This is not about controlling your breath, but is simply about noticing that you are breathing. Notice the air moving in through your nostrils, passing through your throat, and into your belly as you inhale.  Follow your breath out through your mouth as you exhale. You may notice that your breath slows down as you focus on your breath.  A comfortable rate is approximately six breaths per minute (6-7 seconds on inhale and 6-7 seconds on exhale).

As you sit and observe your breath, you will find that your mind wanders to different thoughts, ideas, worries, or plans. This is normal and is the brains natural default state. Rather than engaging with your minds thoughts, simply notice that your mind has wandered and then gently bring your attention back to your breath. If you find yourself feeling frustrated or self critical, again, just simply notice that you had the feeling (without judging) and guide your attention back to the breath.

When the timer goes off, allow yourself to slowly return to your day.

When you practice this daily, you will strengthen the neural connections in your brain that are important in maintaining focus and regulating behavior. As with any skill, the more you practice, the better you will become. Many people find that doing this practice regularly helps them to feel more centered and in control. However, even skilled meditators sometimes find themselves having difficulty focusing. It is during these unfocused times that you are training!

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What I learned from almost losing my daughter

Two years ago my beautiful granddaughter was born. It was one of the happiest days of my life. However, it did not go off without difficulty. My daughter had Graves’ disease which made her pregnancy high risk. Additionally, although her labor was short, part of the placenta was retained in the birth canal after the baby was born, causing her to hemorrhage. For the next five hours my daughter lost a tremendous amount of blood. Her heart rate fluctuated between 140 and 180 bpm and she was in intense pain.  When her doctor finally returned, he was able to stop the bleeding, and we felt that she was out of danger. A few days later, she was discharged from the hospital. She struggled with postpartum depression, likely due to anemia, but settled in to being a mother. 

Fast-forward approximately six months. My daughter was feeling fatigued. Fatigue is expected when your new mother but this seemed to be in excess of what we would expect. She went to the health clinic and was immediately sent to the emergency department. I’ll never forget when she called me to tell me that she had a pulmonary embolism. I’ll also never forget the next day when she called from the hospital after being told that she was in heart failure and was having episodes of ventricular tachycardia. For those that don’t know what ventricular tachycardia is, it is an abnormal rhythm of the heart that can lead to cardiac arrest. I remember looking at my granddaughter, who lay sleeping beside me while her mom was in the hospital, feeling so worried that something might happen to her mother.

We spent the next year traveling from one specialist to the next. My daughter was put on bed rest for months and was having several episodes of arrhythmia. My granddaughter came dangerously close to losing her mother. I came dangerously close to losing my daughter. Despite all of the training I received in mental health, there were times that it felt “impossible” not to worry.

Shortly after life started to settle down, the 2016 election cycle began. I don’t need to tell you how stressful it was watching such a divisive and hateful process, because we all went through it in one way or another. But again I felt that I was being pulled into worry about what lies ahead for our country.

Through both of these experiences, each still ongoing and at times overwhelming, a couple of important life lessons have become very clear to me:

It is important to acknowledge the limits of my control in any given situation.

Acknowledging the limits of our control is very difficult but holding on to the illusion of control doesn’t change the outcome. It just creates more stress as we focus all of our energy into trying to control things that are not within our reach. By acknowledging that we do not have the power to control certain things, we free ourselves to put energy into what we CAN affect.

In reality, I cannot be with my daughter 24/7 and therefore, I cannot stop my daughter from having a cardiac arrest if that is what is going to happen. I cannot make her medical decisions for her, even if I feel her decisions are risky. But I CAN research her condition and give her information that may help her. I CAN take a refresher course in CPR and purchase an AED. I will be there if and when she needs me. 

Likewise, I cannot stop the President from tweeting and I cannot make members of Congress act in a way that I want them to. But I can march or write to my Representatives to give them my input. I can (and will) vote. I will consider becoming more involved in politics. I will continue to speak from the heart and be loyal to my values. 

It is important to live in the moment and to not get too attached to the outcome.

I realize that this may sound ludicrous. How do you not get too attached to what happens to your child or with the world? However, going back to the first point, no amount of worrying is ever going to change that hard fact that we cannot control the situation. Worrying only steals from our enjoyment of today. I know there were many times in my life (and I’m sure yours) that I have worried about something and it did not happen. How much time do we waste on worries that never come to fruition? And if something tragic were to happen, how much would we regret that we did not enjoy the time that we, or our loved one, had? No one ever looks back from their deathbed wishing that they had worried more.

Engaging in worry is a habit and one that takes a lot of time and energy to break. Mind-body practices such as meditation, yoga, progressive muscle relaxation, and tai chi help you to practice being in the moment. Mindfulness meditation is a form of meditation that teaches us to accept life as it is and to be “present” and has been found helpful with people with chronic illness, anxiety, or other illnesses. I knew all of this, but making the time to engage in these activities, in the midst of the stresses was necessary.

Lastly, sometimes you cannot do it alone.

I am thankful that I have a good, supportive network of people that I can turn to. My husband and family are there for me, and I certainly used them as sounding boards when I was feeling stressed. Being in the healthcare industry (and mental health, to boot) I have several friends with training in dealing with stress, and aside from just offering a shoulder, they would remind me to take care of myself, as I have reminded them when they needed it.

But sometimes we may not feel that we want to burden our friends and/or family. This may be particularly true in times like today when our friends and family may be on the other side of politics. Or, they may be feeling overwhelmed and may not be in a position to see your problem clearly and without bias. Additionally, chronic stress can lead to clinical depression, and may require more help than your friends can give. At times like this, it can be important to turn to a psychologist or therapist for professional help.  

I have always reminded myself of the saying: show up, pay attention, tell the truth, but don’t be attached to the outcome. I remind myself every day that as long as I show up, and do everything within my power to make the world better, I can, and will, be okay with the outcome.

 

 

 

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4 Causes of Memory Loss that Might not be Alzheimer’s

A dear friend of mine recently confided to me that she was worried about her memory.  Jodi is the kind of woman who seems to do it all. She is running her own successful business, has an active social life, and is constantly running from one super cool event to another. Over the last few months she has been noticing that words were not coming to her as easily as they used to. She has also noticed that she is having more “senior moments”.  She has found herself in a room, but was not able to remember what she went into the room to do. Her biggest fear is that she is developing Alzheimer’s disease.

As a neuropsychologist, I see people like Jodi every day. I, too, worry about developing Alzheimer’s because I have a family history. And it’s understandable that many are concerned. One in nine people age 65 and older have Alzheimer’s disease and as our population ages, the more people will be affected.

Alzheimer’s disease has become many people’s biggest fear. I have had very high-ranking military officers (retired) break down in tears in my office because they were afraid they would be dependent on others in their final years. Because although being diagnosed with a disease like cancer or cardiovascular disease is devastating, dementia robs you of your essence and your independence. And at this point, there is no real cure.

However, it is important to remember that there are many other potential culprits that can affect your memory. Some are actually reversible. Here are just a few:

Insufficient Sleep

No one would question the need for sleep. Anyone who has ever pulled an all nighter, or has taken care of a newborn baby,  knows how it feels when the body needs rest. However, what might be surprising is that lack of sleep can actually have a major impact on your cognitive functioning. Sleep deprivation impairs functions such as sustained attention, visual spatial processing, and reaction time. One night of sleep deprivation has been found to have the same effect as intoxicating blood-alcohol levels on simulated driving tests.

Additionally, learning new information requires three steps, all of which can be adversely affected by sleep deprivation:

  • Acquisition: acquiring and attending to new information is the first step in learning
  • Consolidation: new information is transferred from short term memory to longer term memory and becomes stable
  • Retrieval/Recall: pulling up the information, when needed

As you can see from above,  sleep deprivation can certainly affect the acquisition stage of learning by interfering with basic sensory and attentional processes. However, lack of sleep can also affect the consolidation of new information, because our brains consolidate (file away) information while we sleep. It’s like taking the papers on your desk and filing them neatly in a file cabinet.  If you don’t sleep, your brain does not have the time to file the papers into “longer-term” memory files. Thus, things that we hoped to learn, are not retained.

Alcohol, Sleep Aids, and Other Substances

Many adults enjoy an occasional glass of wine or mixed drink, and there is some support for the beneficial effects of drinking in moderation. However, few people truly limit consumption to a glass a day. Research suggests that older people, on average, are drinking more than they used to (link to CNN story). With this in mind, it is important to remember that as our bodies change, our body’s ability to metabolize alcohol (or other substances) also changes. Alcohol and other substances stay in our bodies longer, and can affect our functioning the next day. Although we may have been able to handle two or three drinks, in our 20s, we may only be able to handle one, in our 50s or 60s. This can also be true of pain medications and recreational drugs.

Additionally, the use of some typical over-the-counter medications, particularly anticholinergic medications such as diphenhydramine (the active ingredient in Benadryl and many OTC sleep medications) can cause brain fog and may possibly have more chronic effects (link to JAMA article).  So can other medications. So before jumping to the worst case scenario (Alzheimer’s), cut back on your alcohol consumption , look in your medicine cabinet, and talk to your doctor.

Other Treatable Medical Conditions

There are also a few medical conditions that can mimic dementia and often these are overlooked as we rush to the worst case scenario in our minds. For example, thyroid imbalances can cause fatigue, depression, dysregulation of body temperature, headaches, anxiety, decreased concentration, and memory problems. Women have a ten-fold risk of developing thyroid conditions, and this risk is even higher during pregnancy or menopause. Both overproduction (ex. hyperthyroidism, Graves’ disease) and underproduction of thyroid hormones (ex. Hashimoto’s) can cause dementia-like symptoms, so it may be important to rule out endocrine conditions.

Other conditions often overlooked include conditions such as pernicious anemia (B-12 deficiencies), urinary tract infections (UTI), diabetes, and the list goes on. Hydrocephalus (an abnormal accumulation of cerebral spinal fluid within the brain) is usually accompanied by cognitive problems, poor balance or changes in gait, and urinary incontinence, and is sometimes mistaken for dementia. If caught early, these conditions can often be reversed.

Stress and Depression

If you (or someone you love) has been told that you have “pseudo-dementia”, this is a real thing! Pseudo-dementia is a term used to describe cognitive changes due to depression. Aside from feeling sad or down, symptoms of depression include diminished interest (apathy), insomnia (or, on the other hand, hypersomnia), fatigue, and diminished ability to think or concentrate. 

I cannot tell you how many times a patient has come to me for an evaluation, and after reviewing their history and their symptoms, we find that they are depressed or under a great deal of stress. Oftentimes, they show cognitive deficits on objective memory tests, yet when they return for re-evaluation after being treated for depression, they show improvement or even a return to their baseline. Depression can interfere with working memory and attention, both important in the formation of new memories (link to NIH Depression). Deficits have also been found in studies examining explicit verbal and visual memory.

Now, I am not suggesting that being under stress or being depressed rules out dementia. People who are developing dementia offen experience stress as they are beginning to struggle with tasks they used to be able to handle well. Furthermore, depression is often a symptom during the early stages of dementia. However, depression and stress can also CAUSE cognitive  problems, and looking at how much stress we are under (or how many balls we are juggling) may be enlightening. And making lifestyle changes, such as cutting back long hours at work, dividing caregiving and household chores between others, and engaging in health promoting activities such as yoga, meditation, and exercise may help.

With all this said, it is important to take cognitive changes seriously, particularly when you have a family history of Alzheimer’s disease. Although many times treatable causes are found, there are other times that these subtle signs are a harbinger of future problems.

If you are noticing cognitive changes schedule an appointment with your doctor or neurologist. Aside from the above conditions and tests, your doctor may refer you to a neuropsychologist (like myself) for memory testing, and/or suggest other tests (i.e., MRI, EEG, blood work, PET, genetic studies….) that can help you understand the changes you are experiencing. But most importantly, try not to worry too much right now. Because what you are facing is not always what you fear.

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Vocational and Learning Disability Testing

Student’s often leave high school and struggle in college. This is especially true for students who have struggled with learning difficulties and/or Attention Deficit/Hyperactivity Disorder (ADHD). While in school, the student may have had a Individualized Educational Plan (IEP) or at the very least, may have had the support of a parent or concerned teachers, who provided structure that the student needed. When the student begins college, that structure is not automatically there, and it is the responsibility of each student to ensure that they have what they need to succeed.

If you (or your child) are transitioning from high school to College, it is important to discuss this transition with the guidance counselor at school or with a disability counselor at the College or University that you plan to attend. IEP’s and 504 plans do not automatically follow the student to college and it is important to ensure that needed services and supports remains available. This may mean having an updated psychoeducational evaluation completed to provide to the disabilities office.

After talking with a guidance counselor, it may also be helpful to contact the Department of Education and Vocational Rehabilitation in your state. The Department of Education may be able to arrange psychoeducational testing to be done to assist in the transition.

Another instance that Psychoeducational testing may be sought by student is to obtain accommodations (i.e., extra time on the test, etc.) on standardized testing (i.e., SAT, LSAT, MCAT, GRE, GMAT, etc.). Assessment for the need for accommodations in high stakes testing is very stringent and may or may not result in the student being granted accommodations. However, this testing may be required if accommodations are desired.

It is important to know that traditional medical insurance plans do not generally cover the cost of assessment, unless there is an underlying medical condition (i.e., seizure, traumatic brain injury, etc.) and a doctor deems the assessment medically necessary. Even then, much of the testing may not be covered. Contact the representative of your health plan for information regarding your plan.

Please contact us for further information.

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Testing for Memory Loss

People often ask their primary care doctors about Memory problems. Oftentimes, PCPs and neurologists will send you to a neuropsychologist. A neuropsychologist is a licensed psychologist who specializes in neurologic conditions (i.e., Alzheimer’s disease, Parkinson’s disease, etc) and who assesses brain functioning through cognitive testing.

Memory Testing for older adults generally lasts approximately 2 to 3 hours; although testing can be longer if you are a younger person (under the age of 60) or if you’ve suffered a brain injury or have another neurologic condition.

Testing generally involves a paper and pencil test. You will also meet with the neuropsychologist to review your medical history prior to beginning testing. After that, she will test your memory and other cognitive skills, such as language and visual spatial skills.

At our practice, we strongly believe that your comfort is very important so that you are able to perform at your very best. We try to make the environment as relaxing as possible and will make needed accommodations so that you are comfortable. Please feel free to contact us if you have any questions.