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Prescribing CreativityHow the 6th vital sign can help you re-energize
your career, decrease stress, and have more fun
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Recognize the prolific power of FLOW
5. Acquire tips to rescue your right brain
6. Put it all together as the 6th Vital Sign
@AmAcadOsteo
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Acquire tips to rescue your right brain
5. Recognize the prolific power of flow state
6. Put it all together as the 6th Vital Sign
@AmAcadOsteo
Creativity Equation
New + Useful
= Creative@AmAcadOsteo
“The newness in
the individual psyche
is an endlessly varied
recombinationof age-old components.
-Carl Jung
“A good poet will usually
borrow from authors remote in time.
-T.S. Eliot
@AmAcadOsteo
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Acquire tips to rescue your right brain
5. Recognize the prolific power of flow state
6. Connect to your intuition for happiness
7. Put it all together as the 6th Vital Sign
@AmAcadOsteo
@AmAcadOsteo
@AmAcadOsteo
@AmAcadOsteo
The doctor
will see you
now.
Medscape Report 2019
44%
burned out
@AmAcadOsteo
Medscape 2019 review
45-54 year olds
@AmAcadOsteo
Medscape National Physician Burnout, Depression & Suicide Report 2019@AmAcadOsteo
@AmAcadOsteo
DIAGNOSIS:
W55.29 = OTHER contact with a cow
F43.0 = Acute stress reaction
Z73.0 = Burnout@AmAcadOsteo
Recognize the
arrhythmia
before it flatlines
Health Professional
Burnout● Depersonalization
● Emotional exhaustion
● Perceived low personal
achievement
= GRIEF.
STRESS● Over engagement
● Emotionally overactive
● Urgent/hyperactive
● Easy to treat
● Self-recognition
● Damage is physical
● Increased risk of medical
conditions
BURNOUT● Disengagement
● Emotionally blunted
● Hopeless
● Detachment
● Damage is emotional
● Difficult to manage
● Not recognized by self
● Risk for suicide
Gaither, C: Reignite, From Burned out to On Fire. 2018 @AmAcadOsteo
STRESS● Over engagement
● Emotionally overactive
● Urgent/hyperactive
● Easy to treat
● Self-recognition
● Damage is physical
● Increased risk of medical
conditions
BURNOUT● Disengagement
● Emotionally blunted
● Hopeless
● Detachment
● Damage is emotional
● Difficult to manage
● Not recognized by self
● Risk for suicide
Gaither, C: Reignite, From Burned out to On Fire. 2018 @AmAcadOsteo
SO WHAT’S THE BIG DEAL?
● ⬆ medical errors
● ⬆ healthcare costs to public (40% turnover)
● ⬆ medical claims by employees (114%)
● ⬇ patient outcomes, ⬇ satisfaction (27%)
● Estimated shortage of 90,000 physicians by 2025
● Substance abuse, divorce, suicide
Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review Louise H. Hall ,et al Published: July 8, 2016
https://doi.org/10.1371/journal.pone.0159015
$630,000to replace 1 PCP
@AmAcadOsteo
AMA “STEPS FORWARD”
@AmAcadOsteo
Academic Hospital
7.4
$3,720,472
500 27
@AmAcadOsteo
@AmAcadOsteo
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Acquire tips to rescue your right brain
5. Recognize the prolific power of flow state
6. Put it all together as the 6th vital sign
@AmAcadOsteo
DepersonalizationGrief
Automation
Meaningless
Lack of sleep
StressOvereat
CellularPhysiology
Isolation
Prefrontal cortex
@AmAcadOsteo
@IIDA.WI
DNA aged 6 years during the
first 12 months on the job.
Telomere shorteningdirectly proportional to hours worked
and perceived stress
@AmAcadOsteo
ACE studyAdverse Childhood
Events
https://www.cdc.gov/violenceprevention/child
abuseandneglect/acestudy/index.html
“Adverse
Doctor
Events?”
@AmAcadOsteo
@AmAcadOsteo
“Intestinal permeability….
..results in metabolic endotoxinemia.”
@AmAcadOsteo
Intestinal
Permeability
You need
some help.
inflammation
inflammation
inflammationinflammation
inflammation
inflammation
@AmAcadOsteo
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Recognize the prolific power of FLOW
5. Acquire tips to save your right brain
6. Put it all together as the 6th Vital Sign
@AmAcadOsteo
BURNOUT
● Emotional exhaustion
● Depersonalization
● Low perceived
achievement
ENGAGEMENT
● Emotional energy
● Resiliency and vigor
● Sense of significance
● Enthusiasm
● Deeply engrossed
● Selflessness
@AmAcadOsteo
Engagement is also….
Creative
Flow state
@AmAcadOsteo
● Selflessness
● Timelessness
● Effortlessness
● Richness
Mihaly Csikszentmihaly @IIDA.WI
@AmAcadOsteo
The amount of time spent in
a creative task showed DIRECT correlation to
amount of positive affect and wellbeing
long after activity ceased
“Unnecessary Creating”,
creating for ourselves rather
than for others.
When we spend much of our
time in on-demand creating,
we can quickly lose touch with
the passions that fuel our
best work
@AmAcadOsteo
@AmAcadOsteo
80% indicatedthat the music therapist’s practice improved their caregiving experience…
Lowered perceived pain and stress
when surgeons are in “flow,”
…..complex tasks feel effortless;
...highly engaged and less likely to
make errors@AmAcadOsteo
What is happening in
our bodies?
@AmAcadOsteo
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Recognize the prolific power of FLOW
5. Acquire tips to GROW your right brain
6. Put it all together as the 6th Vital Sign
@AmAcadOsteo
Neuroplasticity
“The enemy of art is
the absence of
limitations.”
--Orson Welles
Creativity needs:
M.I.N.D.
@AmAcadOsteo
Mitochondria
Integrate
Notice
Divergent
@AmAcadOsteo
@AmAcadOsteo
@AmAcadOsteo
@AmAcadOsteo
Flavonoids and Mood
● Flavones bind to GABA(A)
receptors
○ Anti-anxiety
○ Anti-convulsive
● Neuroprotective properties
● Influence mood
@AmAcadOsteo
Carbohydrate enriched diet =
Anxious and depressive
behaviors
@AmAcadOsteo
Alpha
Beta
We crave hypofrontality@AmAcadOsteo
Prefrontal cortex
Alpha Waves =
● Sensory input minimized
● Clear of unwanted thoughts
● Relaxed wakefulness
@AmAcadOsteo
Brain Derived Neurotropic Factor
@AmAcadOsteo
Bilateral exercise promotes
brain plasticity by producing
BDNF
Increased ENERGY
anti-inflammatory
@AmAcadOsteo
Creativity is about living creatively. We all
have the capacity to dream, explore, discover,
build, ask questions, and seek answers…. inviting
us to explore and express our own unique set of
qualities …..and to
connect the dots in a way that
they’ve never been connected before.
—Scott Barry Kaufmann Wired to Create
“
@AmAcadOsteo
significant improvement
in their observational skills
“Ideas arose in crowds,
colliding until pairs interlocked,
and a stable
connectionwas made.”
-Henri Poincaré
@AmAcadOsteo
Sustained
28% reduction in
perceived stress and depression (16 percent) in health-care
practitioners.
Cheng., S., et al. “Improving mental health in health care practitioners: Randomized controlled trial of a gratitude intervention.” Journal of Consulting and Clinical Psychology Vol. 83 no. 1, (2015): 177-186. @AmAcadOsteo
Practicing gratitude led to a
7% reduction in
biomarkers of
inflammation in
patients with CHF
Psychosom Med. 2016 Jul-Aug;78(6):667-76. Pilot Randomized Study of a Gratitude Journaling Intervention on Heart Rate Variability
and Inflammatory Biomarkers in Patients With Stage B Heart Failure.
@AmAcadOsteo
Korb, Alex. The upward spiral: Using neuroscience to reverse the course of depression, one small change at a time. (2015: 194).
Gratitude rewires our neurology by
creating a
positive feedback
loop by route of
dopamine.
@AmAcadOsteo
@AmAcadOsteo
“Making stuff” can help students
prepare for such failures in a
controlled environment that doesn’t threaten their
professional identities.
This facilitates resiliency.
@AmAcadOsteo
@AmAcadOsteo
“Editing family movies,
writing a short story or essay,
rearranging your furniture,
songwriting,
developing a concept for a
new business, or
anything that requires you
to exercise a degree of
creative thought can
count.”@IIDA.WI
VISUALIZATION
RED ENERGY BLUE ENERGY
1. Prove you are inherently creative
2. Identify if you’re stressed or burned out
3. Discover how stress impacts your body
4. Recognize the prolific power of FLOW
5. Acquire tips to rescue your right brain
6. Put it all together as the 6th Vital Sign
@AmAcadOsteo
WHAT IF I TOLD
YOU
WE CAN MAKE THIS
HAPPEN @AmAcadOsteo
@AmAcadOsteo
The power of….
Prescribing Creativity
@AmAcadOsteo
@AmAcadOsteo
@AmAcadOsteo
ART
HAPPINESS
@AmAcadOsteo
HEALING
@AmAcadOsteo
When the artist is alive in any person,
whatever his kind of work may be, he
becomes an inventive, searching, daring, self-
expressive creature….he disturbs, upsets, enlightens,
and opens ways for better understanding.Where those are trying to close the book, he opens it
and shows there are still more pages
possible.-- AMERICAN PAINTER ROBERT HENRI
“
Mitochondria
Integrate
Notice
Divergent
@IIDA.WI
Dr. Lara Salyer, DO, IFMCPDrLaraSalyer.com
#6thvitalsign
@AmAcadOsteo
AAO2020
© 2020 Lara Salyer, www.RightBrainRescue.com
Prescribing Creativity
Convocation March 2020
#6thVitalSign
Adults who are more playful and creative are reported to feel less stressed, exhibit bettercoping mechanisms, and achieve greater life satisfaction.
By honing our creative skills, we will intuitively: make accurate decisions that align better with our core values find alternative choices that help us live with less stress perform at a higher, more efficient standard have more fun, which benefits our personal health connect on a deeper level with others All day long, we use the executive (pre-frontal) cortex of our brain to analyze and makedecisions. Meanwhile, our creative (default) networks of our brain are dampened. :( This means less spontaneous and effortless thinking happens when we are in a careerthat uses large amounts of executive functioning. It's worse when this same careerautomates many of our duties, leaving little room for innovation and expansion! Fortunately, our brains are neuroplastic and flexible---able to make new connections daily. We can learn and adopt the keystone characteristics of creative individuals!
Keystones of Creativity:
Perceptive to surrounding environmentOpen to self-discoveryAble to extract order from complexityInnate drive for explorationCritical sense of conscientiousnessWilling to take risks for independent thinking © 2020 Lara Salyer, drlarasalyer.com
[ depersonalization + grief ]
burnoutDisengaged ("I don't care about this any more.") Emotionally blunted ("I feel robotic.")Hopeless ("Is this even important? Nothing matters.")Detached ("Who cares about the outcome. I don't.")Physical and emotional exhaustion (".........")
FLO
W
(OPTIMAL ENGAGEMENT )
Creative Flow StateSelflessnessTimelessnessEffortlessnessRichness
© 2020 Lara Salyer, rightbrainrescue.com
Make space to find your stillness Capture and record your ideas
How to start:
User Manual for your Brain
GLUTAMATE
DOPAMINE
GABA
SEROTONIN
Excitatory neurotransmitterInvolved in learning and neuroplasticityImbalance noted with migraines,bipolar, epilepsy, ALS
Motivation neurotransmitterCognition and motivationImbalance causes hallucinations,paranoia, ADHD, fatigue
Mood neurotransmitterInvolved in stabilizing happiness, wellbeing,alertnessImbalance causes anxiety, OCD, depression
Inhibitory neurotransmitterImbalance causes anxiety,seizures.
ACTH Produced by pituitary
Increases cortisol production in adrenals
Sleep deficit, caffeine, Cordyceps, Panaxginseng, insulinMeditation, Ashwaganda, L-theanine,Valerian, magnesium Tryptophan, 5HTP
Alcohol, statin medication,artificial sweeteners
Vit B6, L-Theanine,Taurine, AshwagandaBenzodiazepines(Xanax), Ambien
B6 deficiency, stress, MSG Taurine, L-Theanine,CoQ10, Valerian, Zinc
Tyrosine, exercise,meditationMagnesium deficiency,sugar imbalance
Basic Housekeeping Essential Fatty Acids (EFA) improvemembrane cell transmissionIntermittent Fasting boosts BDNF(growth hormone for the brain)Melatonin (protects brain fromoxidative injury)Regular exercise improvesoxygenation, signalling
drlarasalyer.com
= these things INCREASE levels
= these things DECREASE levels
FATSCARBS
PROTEINS
ENERGY!(ATP)
ATP
ATP
OXYGEN
ANTI-OXIDANTS, ANTI-INFLAMMATORY: TURNS ON NRF-2
Meet Your Mitochondria
INFLAMMATION AND OXIDATIVE STRESS:TURNS ON TNF alpha & NF-kB
Gut bacteria (microbiome)Increasing age
Lipid peroxidasesDamaged DNA
(8 OH-Deoxyguanosine) Free Radicals
UV lightElevated HbA1c
OrganophosphatesHeavy Metal toxicity
Cooking methods (burned food)
Gut bacteria (microbiome)
riboflavinniacin
L-carnitineCoQ 10
Alpha Lipoic AcidVitamin C, K, and E
Phosphatidyl CholineGlutathione
Iron, MagnesiumAcetyl CoA
Flavonoids, GarlicBroccoli, Green Tea
Curcumin, CinnamonTrans-Resveratrol
Gingko Biloba drlarasalyer.com
STRESS AND CORTISOL
LOW CORTISOL
HIGH CORTISOL
S T R E S S
Ashwagandha (2 - 4 g per day)Rhodiola (200-600 mg per day)Cordyceps (1 gram per day)Siberian ginseng (500 mg twice daily)St. John's wort (300 mg three times daily)Phosphatidyl serine (500-800 mg 1 hourbefore bedtime)
Ashwagandha (2 - 4 g per day)Licorice (100-200 mg twice daily)Cordyceps (1 gram twice daily)Asian ginseng (200-400 mg daily)Rehmannia (400-800 mg daily)Possible DHEA (if deficient)Aggressive circadian rhythm
coaching and support
INITIAL STRESSAshwagandha (2 - 4 g per day)L-theanine (200 mg as needed up
5-Hydroxytryptophan (5-HTP) 100-200mg 1 hour before bedtimePassion Flower (1 gram three times daily)Valerian root (100-200 mg twice daily)Kava kava (300 mg twice daily) Schisandra (100 mg twice daily)
to 1200 mg maximum)
HPA axis isactivated and
triggers cortisolrelease
Cortisol in
creases blood pressure,
heart rate, and changes metabolism
biochemistry instantly.
drla
rasa
lyer
.com
This is intended for EDUCATIONAL PURPOSES ONLY. It's strongly recommendedthat you have accurate diagnosis with testing and that you work with yourphysician. Like many pharmaceutical-grade drugs, side effects can occurwith botanical agents. These interactions can cause herb/drug and herb/foodor nutrient interactions from mild to life-threatening. ALWAYS CONSULT AFUNCTIONAL MEDICINE PROVIDER.
If left unchecked, cortisol willremain elevated and HPA axis
becomes more imbalanced
Chronic stress will cause
severe dysregulation and
cortisol levels are depleted
ALA LA
GLA
AAEPA
DHACold water fish, wild game,
enriched eggs, algae
EicosatetrinoicAcid
Di-homo-gama-linolenic Acid
Adrenic Acid
DocosapentenoicAcid 5n-6
deltade
6
deltade
oxidation
More inflammatoryEicosanoids
Less inflammatoryEicosanoids
drlarasalyer.com
Understanding Fatty AcidsOMEGA 3 OMEGA 6
Canola, soy, flaxchia, hemp, walnuts
Cold water fish, wild game,enriched eggs
Sunflower,peanuts,safflower,
vegetable oils
Borage, blackcurrant seed,
evening primrose
Dairy, shellfish,animal fat
Stearidonic Acid
DocosapentenoicAcid 5n-3
SAT
deltae
deltae
6LONG
5SAT
5LONG
Less inflammatoryEicosanoids
Inhibits
Less inflammatoryEicosanoids
Rate Limiting(alcohol and age blocks)
OMEGA 3OMEGA 6 : RATIO Current population average is 16:1 (ideal is as close to 1:1)
3:1 suppressed inflammation in Rheumatoid Arthritis2.5:1 reduced rectal cell proliferation in those with rectal cancer5:1 had beneficial effects on asthma (10:1 did not)4:1 associated with 70% decrease in mortality with CVD
Rxprescription
M
I
N
D
Mitochondria make their energy from oxygen and quality fats,
carbs, and proteins.
Practice deep breathing to increase oxygen supply
Eat foods that nourish your cells with phytonutrients
Supplement with nutritious fats (walnuts, fish, avocado)
Integrate your brain hemispheres to increase cross-talk and
synthesize material efficiently.
Participate in bilateral activity daily
Try using your non-dominant hand for usual activities
Find repetitive activity to do with both hands
Notice your external environment and internal state of emotions,
as this will hone your intuitive sense.
© 2020 Lara Salyer, www.rightbrainrescue.com
Pay attention to your body's sensations in response to
environmental triggers or food
Utilize all 5 senses to describe your day
Divergent thought patterns with expansive ideas will help form
new connections in your neuroplastic brain.
Practice coming up with 3 possible stories to explain
someone's behavior towards you today.
Try changing up your routine patterns for 24 hours
© 2020 Lara Salyer, drlarasalyer.com
Your Diagnosis: Right Brain Rx:
Insight TimerMeditation app
Trouble focusing
Misinterpreted Emails
Low energy
Sleep imbalance
Poor patient outcomes
Mitochondrial FoodRecommendations
Circadian Code
Group Visit Toolkit
Pomodoro Technique
Loom Video for VisualCommunication
Anxiety and Stress
Creative Apathy Right Brain Rescue
Free guided meditation app for those new andseasoned practitioners. Educational & inspirational
Helpful method to break time into chunks ofmaximum focus with intentional breaks.
Free screenshare video app to help improvecommunication. Can be password protected.
Top recommendations from Functional Physician,Dr. Mark Hyman, MD.
Current research in balancing innate biorhythms torestore sleep and feeding patterns.
Polished templates, Best Practices, and Done-For-You workflows to implement group visits in office
Online creativity incubator that combines functionalnutrition, neuroplasticity and creativity research
Just what thedoctor ordered!
Carry a blank "Jumble Journal" to dump all your random thoughts and scribbles Have a set of ear plugs for instant silence when needed Fuel your brilliant brain with elements from M.I.N.D. method daily Look at the color "values" of your energy. Are you painting from the same tones? Schedule activities to balance your masterpiece using complimentary colors. Use "negative space" in your Life Canvas. The best music is in the silence. Does your painting project the essence of you or are you trying to please themasses with your theme, colors, and image? Reflect on your "masterpiece" often by viewing yourself in a different light,changing scenery and environment. Always keep your eyes open for new shades and textures to add to your life.
1.2.3.4.5.6.7.
8.
9.
PAINTING your most VIBRANT LIFE:
Dr. Lara Salyer, DO, IFMCP drlara@healthin8.com
www.DrLaraSalyer.com & www.RightBrainRescue.com
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