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HEALING THEHEALER WITHIN:

Integrative Medicine for Self-Care

Julie Rake MS, PA-C Fellow-Integrative Medicine

SACRED CALLINGIMPORTANCE OF WORDS

POWER OF TOUCH

HOPE

TRUTH

LISTENING

CONNECTION

50 Health Care Providers 10 Non-MD’s 10 Complimentary and Alternative

Providers Mid 30’s to late 70’s 8 Recurring themes

ANNALS OF INTERNAL MEDICINE “Healing Skills for Medical Practice” Improving Patient Care. November 18, 2008

EIGHT TRAITS THAT MAKE A PROVIDER A HEALER

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1. Do the little things

2. Listen

3. Be open

4. Find something to like, or love about the patient

EIGHT TRAITS THAT MAKE A PROVIDER A HEALER

5. Remove barriers

6. Let the patient explain

7. Share authority

8. Be committed and trustworthy

EIGHT TRAITS THAT MAKE A PROVIDER A HEALER

Why Do We Become Health Care Providers Anyway? Caring Compassionate Desire to serve Desire to heal Make the world a better place Serve our community Make a difference

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WHERE DOES BURNOUT START?

Heavy patient workloadShort visitsProductivity demandsUn-user friendly electronic EMRDocumentation requirementsPaperwork, labs and call backsOn call workPatient liability concernsDozens of formulariesFrustrating referral processProvider group/hospital politics

ADMINISTRATIVE TASKS

Psychological strain of being a providerTreating sick, scared, dying patientsExperiencing grief after patient illness or deathDelivering bad news to patients Worry about patients Worry about making the correct diagnosisTreating and caring for chronically ill patients Treating too many difficult patients Managing time with needy patients Navigating pain management issues

WHERE DOES BURNOUT START?PATIENT CARE

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Relationships/spouses to manage time & care withNavigating break-ups and divorceCaring for children or special needs childrenAssisting with and caretaking for aging parentsManaging difficult family issues like addictionEnduring and managing financial pressuresHouse work, errands and daily pressuresManaging personal challenges like grief or lossManaging personal health and wellness issuesManaging mental health issues such as anxiety

WHERE DOES BURNOUT START?PERSONAL AND HOME LIFE

BURNOUT:THREE CARDINAL SYMPTOMS

Exhaustion=physical and emotional exhaustion. You are tired on physical, emotional and spiritual levels.

Cynicism (Depersonalization)=you have lost your ability to care, empathize, and connect with your patients, staff and co-workers and feel guilty about it.

Doubt=you may begin to doubt that your work really makes a difference or question the quality of what you do.

American Academy of Family Physicians. Physician Burnout: Its Origin, Symptoms, and Five Main Causes. www.aafp.org Accessed Sept-Oct 15

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The medical profession consistently hovers near the top occupations with the highest risk of death by suicide.

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In the recent past science taught us the brain was static Neuroscience is now teaching us the brain is malleable Our environments, behaviors and thinking shape our brain We can use the principles of neuroplasticity in our favor It has been fairly recently discovered that the brain can

generate new neurons These neurons can likely migrate to damaged brain areas

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RS Ulrich. View Through a Window May Influence Recovery From Surgery. Journal Science 1984;Vol 224 pp420-421

PROUTY GARDEN AT BOSTON CHILDREN’S HOSPITAL

Psychologist Robert Ulrich was one of the first Americans to research the effects of nature, and

views of gardens and trees in speeding healing times.

Esther Sternberg M.D. is Founding Director of the

University of Arizona Institute on Place and Wellbeing.

This institute links biomedical, health professionals and design professionals to

research and create places supporting health and

wellbeing.

Building on advances in neuroscience and psychology, researchers have begun to quantify what once seemed divine and

mysterious. “The measurements of everything from stress hormones to heart rate to brain waves to protein markers indicate that when we spend time in nature there is something profound

going on inside our brain.”

G. Bratman. “Nature Experience Reduces Rumination and SubgenualPrefrontal Cortex Activation.” PNAS Accessed July 14, 2015

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JUST PRIOR TO 100 YEARS AGO PROCESSED FOODS WERE MERELY NON-EXISTENT

Fruits Vegetables Nuts Seeds Legumes (beans)

Whole grains Fish from unpolluted waters Animals grazed on grass Eggs, milk, butter and cheese

from those grass fed animals

THE PROCESSED FOOD EXPLOSION STARTED IN AROUND 1900:

Stabilizers Fillers Thickeners Pesticides Trans fats Nitrates and nitrites

Food additives Food colorings Artificial flavors Artificial sweeteners Preservatives MSG

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PROCESSED FOOD, PLEASURE AND ADDICTION

High glycemic loads, chemicals, flavors and sweeteners in processed foods stimulate the reward centers of the brain.

Eating a Krispy Crème donut or Ben & Jerry’s ice cream causes a massive release of dopamine in our brain’s pleasure centers.

When this act is repeated over and over, the brain see’s the large amount of dopamine available and down-regulates dopamine receptors.

With fewer dopamine receptors we start to crave more of the same thick, fatty, greasy, sugar laden foods to achieve the same amount of pleasure.

Studies on rats show they become as physically addicted to junk food as they do to drugs. Avena et al. “Evidence for Sugar Addiction” Behavioral and neurochemical effects of intermittent and excessive sugar intake. Neuroscience Biobehavioral Rev. May 2007

THE DORITO EFFECT: THE FULLNESS/FLAVOR PROBLEM

The Dorito Effect was an illuminating book written by Mark Schatzker and published in 2015. The book’s central theme discusses how over the last 70

years, American animal and plant breeding has focused on yield, pest resistance and appearance and, in the process, our foods lost an enormous amount of flavor. According to one gruesome statistic from a 2013 Poultry Science article, if humans grew as quickly as a chicken is grown, a 6.6 lb. baby would weigh 660 lbs. after 2 months. To remedy the loss of flavor, a

multibillion-dollar flavor industry has stepped in. These artificially manufactured flavor chemicals incentivize us to eat more of them.

Additionally, they lack natural satiety compounds found in whole foods.

Stabilizers Fillers Thickeners Pesticides Trans fats Nitrates and nitrites

Food additives Food colorings Artificial flavors Artificial sweeteners Preservatives MSG

CHEMICALS AND TOXINS

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CANCER CAUSING CHEMICALS

The preservatives sodium nitrate and nitrite found in deli meats, bacon, ham, and hot dogs have been linked to colorectal, pancreatic and stomach cancers.

Grilled red meat releases a carcinogen called heterocyclic aromatic amines. Sugimura. “Heterocyclic amines: Mutagens/carcinogens produced during cooking meat.” Cancer Science. 2004

Microwave popcorn contains perfluorooctanoic (PFOA) and has been deemed “likely carcinogenic” by the EPA but there are no solid human studies.

HIGH FRUCTOSE CORN SYRUP, CHRONIC DISEASE AND BRAIN NEURODEGENERATION

The late 1960s saw the development of a cost-effective method for producing large amounts of extremely sweet corn-based syrups containing high concentrations of fructose 42-55%.

Most of us are aware of HFCS health effects on obesity, metabolic syndrome, DM2, fatty liver, CVD, oxidative stress but there is a growing body of evidence shedding light on its role in neurodegeneration and dementias.

Mounting research shows HFCS impairs memory by affecting the hippocampus and reduces BDNF which reduces plasticity and leads to neurodegeneration.

PROCESSED FOODS LACK NUTRITIONAL VALUE. EVEN OUR MODERN WHOLE FOODS

HAVE LOST SUBSTANTIAL NUTRITION

Vegetables grown decades ago were much richer in vitamins and minerals. One UT study showed “reliable declines” in 43 different fruits and vegetables. Davis et al. “Changes in USDA Food Composition Data for 43 Garden Crops”, 1950-1999. Journal of The American College of Nutrition. December 2004.

Modern intensive agricultural practices have stripped nutrients. The above sited article suggested “an alarming decline in food quality.”

Meat & fish have lost key nutritional value but will be discussed later.

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They were created in 1901 by hydrogenating atoms onto unsaturated fats thus decreasing rancidity and spoilage and increasing shelf life.

In as early as 1965 there were suggestions in the scientific literature that trans fats could be the cause of the large and rapid increase in coronary artery disease.

We now know trans fats increase LDL and triglycerides, lower HDL, increase the risk of coronary heart disease and promote systemic inflammation.

TRANS FATS

FACTORY FARMING AND OUR HEALTH

Factory farms dominate U.S. food production, employing abusive practices that maximize agribusiness profits at the expense of the environment, our communities, animal welfare and our health.

The animals are given hormones to rapidly increase size and increase milk production.

Crowded, filthy conditions result in the animals being given antibiotics. We are ingesting these, and this can lead to drug-resistant bacteria.

Animal feed is usually a combination of corn and soy meal in which the farmers have used excessive amounts of pesticides.

The USDA estimates there are 10 billion animals on AFO’s.

These animals produce 20 times more waste/manure than is generated by the human population. This is around 335 million tons annually.

This waste carries substances such as chemicals, antibiotics, disease causing pathogens like E. Coli and growth hormones. Many factories store this waste in several football-sized fields, called waste lagoons, which are prone to leaks/spills into creeks and rivers and also contaminate water supplies.

The waste stored in holding tanks & waste lagoons emits large amounts of gasses: methane, ammonia, hydrogen sulfide, and particulate matter.

Producing 1 lb. of beef takes an average of 2500 gallons of water, which is the equivalent of roughly 100 showers.

Weighing in at about 1,250 lbs. at slaughter, the average cow eats roughly 30 lbs. of food each day. More than one third of the world’s grains are used to feed livestock or 64-80% of grains produced in the U.S.

FACTORY FARMING AND THE ENVIRONMENT

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Feed for farmed fish is produced from small ocean fish: anchovies, sardines, etc., but a large majority are fed corn and soy meal.

To keep up with growing demands “high energy” diets result in higher fat content making them vulnerable to fat soluble contaminants like (PCB’s).

Farmed fish food often contains antibiotics, growth hormones and dyes to present the fish as more attractive and colorful in the grocery store.

FARMED FISH

Berries – anthocyanins are a flavonoid substance of water soluble pigments that give grapes, berries and red wine their red, blue or

purple color. Anthocyanins have potent antioxidant properties as well as affect a variety of cell signaling cascades. They are mentioned in the “French Paradox” which attempted to explain the lower rates of

heart disease in French populations. Anthocyanins are associated with reduction of CVD, blocking carcinogen activation, other cancer

protective properties and reduced inflammation.

GRAPES AND BERRIES

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YELLOW AND ORANGE FRUITS AND VEGETABLES AND LEAFY GREENS

Carotenoids, fat soluble pigments responsible for the yellow/orange color have been recognized for their antioxidant properties, and have been

shown to effect regulation of cell growth, modulation of gene expression, and possibly immune response. Studies have shown carotenoids are

associated with a reduction in several chronic diseases (CVS), diabetes type 2 and cancer. Supplements have NOT shown a similar effect. They

are best absorbed with a fatty meal as they are fat soluble.

TOMATOES/RED FRUITS AND VEGETABLES

Lycopene, another carotenoid, is found in red-orange fruits and veggies. Lycopene is one of the most potent antioxidants and has been suggested to prevent carcinogenesis and atherogenesis by protecting

critical biomolecules. Several studies have revealed that those with the highest lycopene intakes had lower prostate cancer risk. Giovannucci

E, et al. “Intake of Carotenoids and Retinol in Relation to Risk of Prostate Cancer.” J Natl. Cancer Inst. 1995

CRUCIFEROUS VEGETABLES

Cruciferous vegetables are rich sources of compounds known as glucosinolates. Evidence is accumulating that diets rich in cruciferous vegetables are associated with lower risk of several types of cancer.

Indole-3-carbinol (I3C) is a compound derived from glucosinolates. In humans, markers of risk for breast cancer are reduced with indole-3-

carbinol administration. Women in the upper decile of cruciferous consumption had significant reduction in the risk of breast cancer. Talalay.

“Phytochemicals from Cruciferous Plants Protect Against Cancer by Mondulating Carcinogen Metabolism.” Nutrition 2001

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LIGNANS AND SEEDS

Lignans are found in the woody portion of plants, the outer coats of seeds, and the bran layer of whole grains and they provide the building

blocks for plant cell walls. Some examples are flax seeds, sesame seeds, sunflower seeds, cashews, pumpkin seeds, poppy seeds and

peanuts. Flax and sesame seeds have lignan content 100x higher than other sources. Evidence for their benefits include slowing progression

of arteriosclerosis, protection against some cancers (ovarian, endometrial, thyroid) and modest reduction in fasting blood glucose

and A1C levels.

MUSHROOMS

Many types of mushrooms are attaining status as a super food. Notethat the common “button”, Portobello and Crimini mushrooms contain

natural carcinogens. If you eat these, cook them well at high temperatures, to break down toxic ingredients. The most nutritious types include Shiitake, Cordyceps, Enoki, Maitake, Reishi and Lion’s mane. Mushrooms contain numerous substances that have antiviral,

anticancer, immune enhancing & anti-inflammatory effects.

AVOCADOS

Avocados offer nearly 20 vitamins and minerals in every serving, including potassium, lutein and folate. They are a rich source of C, E, K and B vitamins, and natural plant chemicals. They are a rich source of

“good” monounsaturated fat. A medium avocado contains 160 calories, 2 grams of protein and 15 grams of healthy fats, which allow us to absorb fat soluble nutrients like beta carotene and its oleic acid (fatty acid) is anti-inflammatory. This rock star is low in carbohydrates, loaded with

fiber, improves lipid profiles and is DELICIOUS!

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DARK CHOCOLATE

Dark chocolates high cacao content has been associated with positive health benefits ascribed to flavanol antioxidants. Most of the health benefits attributed to its flavonoids relate to cardiovascular health. Flavonoids appear to have a role in promoting healthy blood vessel

function by reducing platelet activity and improving endothelial function by increasing vascular-NO-synthase activity. Evidence has shown promise

for reduction of LDL and triglycerides, increased HDL, inhibition of ACE activity and antioxidant activity. Sugar content appears to weaken this

effect. Due to high calorie content sensible use is recommended.

GREEN TEA

There exist numerous ancient texts written by healers which extol this teas strong medicinal value. One of the well studied active constituents

of green tea is epigallocatechin-3-gallate (EGCG) which accounts for more than 40% of the total flavonoid content and is higher than many fruits and vegetables. Green tea has been found to decrease mortality from all-causes including cardiovascular disease. It is thought to confer CV benefits via green tea catechins by increasing HDL and decreasing

LDL and triglycerides. The “Asian Paradox” refers to lower rates of heart disease and cancer in Asia despite high rates of cigarette smoking.

ENVIRONMENTAL HEALTH

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“To waste, to destroy our natural resources, to skin and exhaust the land instead of using it so as

to increase its usefulness, will result in undermining in the days of our children the very prosperity which we ought by right to hand down

to them amplified and developed.”Theodore Roosevelt, 7th annual message, 12-3-1907

PLASTICS

Tips to lower your exposure: Invest in reusable glass Tupperware Never reheat your food in plastic Tupperware Use glass or stainless steel bottles instead of plastic water bottles Buy canned food and products marked “BPA” free Plastics marked “1” “2” “4” and “5” do not contain BPA

BISPHELOL-A (BPA) – in commercial use since 1957 tomake plastics. About 7 billion lbs. manufactured annually.An endocrine disruptor which interferes with our hormones

PLASTICS

Tips to lower your exposure: Phthalates are very prevalent in the health care industry-be aware Purchase phthalate-free cosmetics and household products Avoid using fragrant perfumes, lotions and candles Avoid food packaging and eating fast foods; eat whole foods Found in food and water from plastic wrap & industrial waste

Phthalates used mainly as plasticizer, introduced in the1920’s. Found in children’s toys, enteric coating ofpharmaceuticals, cosmetics, perfumes, nail polish, liquidsoap & many more. They are also endocrine disruptors.

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COSMETICS

Many of the 82,000 ingredients in personal care products are industrial chemicals including carcinogens, pesticides, reproductive toxins, and

hormone disruptors.

1. BHA and BHT2. Coal tar dyes3. Cocamide DEA, Lauramide DEA4. Dibutyl phthalate 5. Formaldyhyde preservative6. Parabens

7. Parfum (a.k.a. fragrance)8. PEG’s9. Petrolatum10.Siloxanes11.Sodium laureth sulfate12.Triclosan

PRODUCTS IN THE HOME

Be aware of purchasing more environmentally friendly products for in home use.

1. Air fresheners2. Scented candles3. Household cleaners 4. Carpet & upholstery cleaners 5. Flame retardants on furniture

6. Replace Teflon cookware7. Replace lead in paint and old pipes 8. Glycol Ethers in dry cleaning chemicals9. Triclosan in antibacterial soaps10. Sodium Hydroxide in oven cleaners

PESTICIDES

DDT and Chlordane pesticides have been banned in the U.S. and around the world. There remain numerous

pesticide chemicals & are classified according to their mode of action: herbicides, rodenticides, fumigants etc.

Know how to limit your exposure. Buy the dirty dozen organic and purchase organic whenever possible Wash all produce prior to eating it Avoid in home pesticides, herbicides and rodenticides, if possible Avoid flea and tick collars as well as baths or dips on pets Be aware of agricultural spraying drift near your home, school or work

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PARKINSONS AND PESTICIDES

Hancock et al. “Pesticide exposure and risk of Parkinson’s disease: A family-based case control study.” Neurology March 2008

Stetka “Parkinson’s Disease and Pesticides: What’s the Connection?” Scientific American. April 2014

WATER POLLUTION

1 billion people lack access to clean water, more than 2 billion people lack access to adequate sanitation, and over 3 billion people suffer from waterborne illness annually. (WHO 2014)

Know your water source Do not refill plastic water bottles, bacterial contamination risk is high Research filters for home water filtration–check NSF International Well water should be tested annually and after flooding If living near factory farms or agriculture be aware of groundwater

AIR POLLUTION

Tips to lower your exposure Visit airnow.gov for current air conditions anywhere Avoid outdoor activities on poor quality air days Avoid exercising by busy roads in general Be aware of industrial pollutants near home & work Avoid exposure to idling cars, buses and trucks

Criteria pollutants are the 6 pollutants used by the EPA to set national quality standards and include: carbon monoxide, sulfur oxides, nitrogen oxides, ozone, lead

and particulate matter.

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HERBALS AND SUPPLEMENTS

One-third to one-half of the U.S. population take dietary supplements

Users are more likely to be women, white, and more financially secure

Sales in the U.S. were 36.7 billion in 2014

In the U.S. dietary supplements are regarded as foods rather than drugs

Their use is growing: we need to be aware of important issues

THE DIETARY SUPPLEMENT DILEMMA

The FDA regulates DS’s under the 1994 Dietary Supplement Health & Education Act. They are regarded as foods rather than drugs, and they

are assumed to be safe unless proven otherwise. A number of companies have chosen to go through independent 3rd party inspection.

Manufacturers who choose independent inspection can do so with one of these: United States Pharmacopeia (USF) National Sanitation Foundation (NSD) Consumer labs

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DRUG METABOLYZING ENZYME SYSTEMS

Supplements and plants can also induce or inhibit these various systems.

A classic example of this is the popular antidepressant St. John’s Wort. It induces the CYP3A4 system and has been shown to

reduce levels of oral contraceptives.

#10 FISH OIL AND OMEGA-3 FATTY ACIDS

Reduce inflammation Lower the incidence and severity of arthritis Lower the risk of heart disease and lower lipids Lower the risk of cognitive decline and depression DHA is the most abundant fatty acid in brain cell membranes Whole food sources are still far superior to supplements

CAUTION: use cautiously in those who have bleeding disorders or are taking blood thinning medications and use a reputable

manufacturer secondary to the potential of harmful contaminants.

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#9 L-THEANINE

An amino acid found as a constituent in green tea Stimulates the production of the inhibitory neurotransmitter, GABA May relieve stress by inducing a relaxing state without drowsiness New studies are looking at L-theanine as a neuroprotective agent

1.) Nathan et al. “The Neuropharmacology of L-theanine: a possible neuroprotective and cognitive enhancing agent.” J Herb Pharmacotherapy. 2006

#8 DEGLYCYRRHIZINATED LICORICE (DGL)

Licorice is a natural demulcent, which means it relieves irritation of mucous membranes by forming a protective film

Used for centuries to help repair damaged or irritated mucosa Many common cases of GERD can be improved by using DGL Other uses include treatment of canker sores, sore throats and coughs

CAUTION: Licorice has an active ingredient called “glycyrrhiza” Too much of this can cause pseudoaldosteronism. Therefore,

purchase deglycyrrhizinated licorice, otherwise known as DGL

#7 COENZYME Q10 (CoQ10)

CoQ10 is found in almost every cell in the body and is a powerful antioxidant Most of us know it as a protective adjunct added onto statin therapy Studies suggest it may also play a role in treatment of heart failure and post-

MI, lowering blood pressure and hyperlipidemia and improving blood sugar

CoQ10 is fat soluble so should be taken with some fat in the evening. Many sources say ubiquinol (its reduced form) is

better than ubiqinone.

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#6 NERVINES

Group of herbs that reduce stress and have a calmative effect

Examples: Chamomile, Lavender, Lemon Balm, Passion Flower, Valerian They can be used as capsules or teas to ease anxiety stress and tension

CAUTION when implementing a “nervine” alone or as a concoction and when combing them with other drugs as they are central

nervous system depressants.

#5 GARLIC

Garlic is a vegetable bulb & a close relative to the leek, chive and onion. Its powerful compound “allicin” has potent medicinal properties. Many of its healing abilities are due to its dense antioxidant properties. Some of the claims made for this potent bulb are preventing

arteriosclerosis and heart disease, lowering cholesterol and BP, boosting immunity and protecting against cancers.

CAUTION: Garlic has mild antiplatelet effects and may enhance blood thinning medications

One study in “Agricultural Food Chemistry” found when compared to 26 spices & characterization of their constituents,

cinnamon ranked #1 for its protective antioxidant levels.

Cinnamon is famous for its antioxidant, anti-inflammatory, antimicrobial, immunity boosting, cancer and heart disease protecting abilities.

It is commonly prescribed for its blood sugar lowering capacity.

CAUTION: Common cinnamon (cassia) contains coumarin, using large quantities can elevate the risk of liver damage.

#4 CINNAMON

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Ginger is a knotted, underground root (rhizome). Active components of ginger are its volatile oils & pungent phenol compounds.

Used for over 2000 years to treat digestion issues, nausea & vomiting Its other purported benefits include reducing osteoarthritis, RA and

migraine ha, chemo and post surgical nausea & vomiting, lowering blood sugar, reducing cholesterol, reducing menstrual pain, may protect the brain from neurodegeneration and many more benefits.

CAUTION: do not take supplement with blood thinners.

#3 GINGER

SCIENTISTS AND CONSUMERS ARE FASCINATED BY THIS GOLDEN SPICE AND ITS ACTIVE CONSTITUENT, CURCUMIN

Curcumin is a potent inhibitor of the lipo-oxygenase and cyclo-oxygenase enzyme system & is able to reduce inflammatory cytokines which drive many of its anti-inflammatory effects.

Purported benefits include: dramatically increasing antioxidant capacity of body, reducing arthritis, reducing inflammatory bowel disease and GI cancer risk, lowers risk of heart disease, cancer prevention and prevents neurodegenerative diseases and depression.

#2 TUMERIC

Probiotics get the number one slot because we are now learning our gut bacteria effect our memory, appetite, weight, immune system, inflammation, cancer risk, coping skills, moods, our

brain and much more Gut bacteria are affected by child delivery method, breast-feeding,

environmental factors, antibiotics, intake of foods like processed foods, artificial sugars and beer.

Gut bacteria have the ability to produce various neurotransmitters such as GABA, serotonin, catecholamine's and acetylcholine.

#1 PROBIOTICS

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EXERCISE AND BRAIN DERIVED NEUROTROPHIC FACTOR

WE NOW KNOW THAT INTENSE EXERCISE PRODUCES A POTENT BRAIN GROWTH FACTOR “BRAIN DERIVED

NEUROTROPHIC FACTOR” (BDNF).

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Greater activity in the amygdala Greater blood flow in and to the amygdala More grey matter in the amygdala Larger size of the amygdala overall

STRESS PHYSICALLY CHANGES THE BRAIN

STRESS PHYSICALLY CHANGES THE BRAIN

Decreased size of the pre frontal cortex Decreased grey matter in the pre frontal cortex Decreased neuronal connections Decreased ability to regulate the amygdala

Cortisol is neurotoxic to neurons in the hippocampus Hippocampus shows decreased grey matter Hippocampus shows decreased size

STRESS PHYSICALLY CHANGES THE BRAIN

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OUR EMOTIONS EFFECT OUR HEALTH

LoveCompassionKindnessAppreciationGratitudeCourageCareJoyEnthusiasmConfidenceTolerancePatienceHonorDignity

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BREATHWORK

MEDITATION

Changes the brain Improves mood Improves emotional well-being Increases optimism and positive

emotions Lessens fear and depression Increases attention/concentration Enhances cognitive skills Improves immune system Reduces blood pressure Decreases inflammation Enhances longevity through

production of telomerase Prevents cognitive decline Increases empathy and social

awareness

1.) National Center for Complimentary and Integrative Health “Meditation” National Institutes of Health (.gov) 20112.) Ricard “Neuroscience Reveals the Secrets of Meditation’s Benefits” Scientific American. November 1, 2014

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MINDFULLNESS

Emerging studies are revealing mindfulness to be a powerful tool to help health care providers become more relaxed, focused, empathic and less emotionally exhausted.

MBSR classes were started by Dr. John Kabat-Zinn in 1979 at Umassto help patients cope with stress and pain

Center for Mindfulness: The University of Massachusettsumassmed.edu

1.) Beach et al. “A Multicenter Study of Physician Mindfulness and Health Care Quality” Annals of Family Medicine. Sept/Oct 20132.) Fortney et al. “Abbreviated Mindfulness Intervention for Job Satisfaction, Quality of Life, and Compassion in Primary Care Clinicians: A Pilot Study.” Annals of Family Medicine. Sept/Oct 2013

Spirituality is a broad-based concept and includes a sense of connection to something bigger than ourselves, and involves a search for meaning in life.

Religion is a codified system of belief, worship and conduct, usually taking place in a group of likeminded believers.

Both religion and spirituality show positive impact on health and longevity. These effects may be due to: including a wise diet, less smoking, less alcohol and drug use and social networks with like minded people.

SPIRITUALITY

Activated when the individual performs a motor act and when he or she observes another person engaging in the same act.

Mirror neurons are also connected with emotions.

Active when people experience happiness, pain, disgust, etc., and when they observe another person experience an emotion.

MIRROR NEURONS

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Understand the patient’s situation, perspective and feelings

To communicate that understanding and check its accuracy

To act on that understanding with the patient in a therapeutic way

A complex multi-dimensional concept which involves an ability to:

HEALTH CARE PROVIDER EMPATHY

Brutal residency schedules Poor medical training Patient-visit time constraints Abundant paperwork & other tasks Burden of workload Avoidance of asking about emotional

problems Healthcare provider burnout

HEALTH CARE PROVIDER EMPATHY

Empathy is susceptible to erosion and often declines due to:

A healthcare provider who is able to create an empathic connection with a patient is actually engaging a complex neural network in the patient, one that has the potential to positively influence the therapeutic outcome.

Physician empathy is linked to better patient outcomes. Research suggests empathetic providers care and concern has a GREATER HEALING IMPACT than procedures and pharmaceuticals in many cases.

HEALTH CARE PROVIDER EMPATHY

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Sometimes our light goes out but is blown again into flame by an encounter with another human being. Each of us owes the deepest thanks to those who

have rekindled this inner light.

~Albert Schweitzer