Migrating to brendashealthplan.com

 I am migrating to brendashealthplan.com - please go there to see my work. Thank you!

Dandelion- Food as Medicine -revised

Dandelion Salad

My mom used to make Dandelion Salad in the Spring with a hot bacon dressing. (Yum!) I could eat the whole bowl.

It needs to be made before the dandelions develop flowers. If you break the dandelion leaf and it has white liquid it's too late.

It tastes like Arugula but the health benefits of dandelion are easily felt. I looked up the benefits of dandelion and this is what I found.

Copied from the University of Maryland medical Center

http://www.umm.edu/health/medical/altmed/herb/dandelion

"Dandelion

While many people think of the dandelion (Taraxacum officinale) as a pesky weed, it is chock full of vitamins A, B, C, and D, as well as minerals, such as iron, potassium, and zinc. Dandelion leaves are used to add flavor to salads, sandwiches, and teas. The roots are used in some coffee substitutes, and the flowers are used to make wines.

In the past, dandelion roots and leaves were used to treat liver problems. Native Americans also boiled dandelion in water and took it to treat kidney disease, swelling, skin problems, heartburn, and upset stomach. In traditional Chinese medicine (TCM), dandelion has been used to treat stomach problems, appendicitis, and breast problems, such as inflammation or lack of milk flow. In Europe, dandelion was used in remedies for fever, boils, eye problems, diabetes, and diarrhea.

So far, there have not been any quality scientific studies on dandelion. Today, the roots are mainly used to stimulate the appetite, and for liver and gallbladder problems. Dandelion leaves are used as a diuretic to help the body get rid of too much fluid.

Hundreds of species of dandelion grow in the temperate regions of Europe, Asia, and North America. Dandelion is a hardy perennial that can grow to a height of nearly 12 inches. The plants have deeply-notched, toothy, spatula-like leaves that are shiny and hairless. Dandelion stems are capped by bright yellow flowers. The grooved leaves funnel rain to the root.

Dandelion flowers open with the sun in the morning and close in the evening or during gloomy weather. The dark brown roots are fleshy and brittle and are filled with a white milky substance that is bitter and slightly smelly.

Parts Used

Dandelion leaves act as a diuretic, increasing the amount of urine your body makes. The leaves are used to stimulate the appetite and help digestion. Dandelion flower has antioxidant properties. Dandelion may also help improve the immune system.

Herbalists use dandelion root to detoxify the liver and gallbladder, and dandelion leaves to help kidney function.

Medicinal Uses and Indications

Most scientific studies of dandelion have been in animals, not people. Traditionally, dandelion has been used as a diuretic, to increase the amount of urine and eliminate fluid in your body. It has been used for many conditions where a diuretic might help, such as liver problems and high blood pressure. However, there is no good research on using dandelion as a diuretic in people.

Fresh or dried dandelion herb is also used as a mild appetite stimulant, and to improve upset stomach. The root of the dandelion plant may act as a mild laxative and has been used to improve digestion. Preliminary research suggests that dandelion may help improve liver and gallbladder function. But this study was not well designed.

Preliminary animal studies suggest that dandelion may help normalize blood sugar levels and lower total cholesterol and triglycerides while raising HDL (good) cholesterol in diabetic mice. But not all the animal studies have found a positive effect on blood sugar. Researchers need to see if dandelion will work in people.

A few animal studies also suggest that dandelion might help fight inflammation.

Available Forms

You can find dandelion herbs and roots fresh or dried in a variety of forms, including tinctures, liquid extract, teas, tablets, and capsules. Dandelion can be found alone or combined with other dietary supplements.

How to Take it

Pediatric

Ask your doctor before giving dandelion supplements to a child so the doctor can determine the dose.

Adult

Ask your doctor to help determine the right dose for you.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs under the supervision of a health care provider.

Dandelion is generally considered safe. Some people may have an allergic reaction from touching dandelion. Others may get mouth sores.

If you are allergic to ragweed, chrysanthemums, marigold, chamomile, yarrow, daisies, or iodine, you should avoid dandelion.

In some people, dandelion can cause increased stomach acid and heartburn. It may also irritate the skin.

People with kidney problems, gallbladder problems, or gallstones should consult their doctors before eating dandelion.

Possible Interactions

Dandelion leaf may act as a diuretic, which can make drugs leave your body faster. It also interacts with a number of medications that are broken down by the liver. If you are taking prescription medications, ask your doctor before taking dandelion leaf. Medications that may interact with dandelion include:

Antacids: Dandelion may increase the amount of stomach acid, so antacids may not work as well.

Blood-thinning medications (anticoagulants and antiplatelets): It is possible that dandelion may increase the risk of bleeding, especially if you already take blood thinners such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).

Diuretics (water pills): Dandelion may act as a diuretic, causing your body to produce more urine to get rid of excess fluid. If you also take prescription diuretics, or other herbs that act as diuretics, you could be at risk of electrolyte imbalances.

Lithium: Lithium is used to treat bipolar disorder. Animal studies suggest that dandelion may worsen the side effects of lithium.

Ciproflaxin (Cipro): One species of dandelion, Taraxacum mongolicum, also called Chinese dandelion, may lower the amount of the antibiotic ciproflaxin that your body absorbs. Researchers do not know whether the common dandelion would do the same thing.

Medications for diabetes: Theoretically, dandelion may lower blood sugar levels. If you take medications for diabetes, taking dandelion may increase the risk of low blood sugar.

Medications broken down by the liver: Dandelion can interact with a number of medications. To be safe, ask your doctor before taking dandelion if you take any medication."

What is Craniosacral Therapy?

Craniosacral Therapy (CST) was pioneered and developed by osteopathic physician John E. Upledger following extensive scientific studies from 1975 to 1983 at Michigan State University, where he served as a clinical researcher and Professor of Biomechanics.

According to Dr. John Upledger, “Craniosacral Therapy (CST), is a gentle, hands-on approach that releases tensions deep in the body to relieve pain and dysfunction and improve whole-body health and performance. Using a soft touch which is generally no greater than 5 grams – about the weight of a nickel – practitioners release restrictions in the soft tissues that surround the central nervous system.”

Craniosacral therapy works with the membranes and fluid that surround and protect the brain and spinal cord. It influences lymphatic fluid and connective tissue. The craniosacral therapist encourages the body to let go of restrictions and improve the flow of fluid. A craniosacral therapist learns to listen and feel for the faint dural pulse of the craniosacral rhythm. It’s a pulse that doesn’t match the beat of the heart or the rhythm of respirations, it’s smooth and full, like the ebb and flow of gentle waves pushing and pulling on a sea shore. Feeling too hard for it can crush the rhythm, too soft and you miss it. Once you find it, you follow the rhythm to flow from the top of the head to the bottom of the feet and back again. It also flows from the front midline of the body, and around the outside of the body to the back of the spine and back around to the front again. I’ve seen pictures of electrical currents making a similar pattern. The therapist is looking for any restrictions, interruptions, or blockages that prevent the rhythm from flowing smoothly and completely. It feels similar to a dance in slow motion, the therapist gently urges the pulse to and fro along the spine and along the path encircling the body and back again. In Craniosacral therapy you are gently encouraging the rhythm to go out a little further, or come back a little closer, to complete and improve the flow of fluid.

 As a client, the body seems to respond to the positive good will and encouragement of the therapist. An understanding develops that the therapist is seeking to help the body heal itself. The encouragement and support, gives permission to stretch a little with the understanding that the therapist is here to guide you and support you.

Dr. Upledger states that “by complementing the body's natural healing processes, CST is increasingly used as a preventive health measure for its ability to bolster resistance to disease, and is effective for a wide range of medical problems associated with pain and dysfunction, including:

• Migraine Headaches
• Chronic Neck and Back Pain
• Motor-Coordination Impairments
• Colic
• Autism
• Central Nervous System Disorders
• Orthopedic Problems
• Concussions and Traumatic Brain Injuries
• Spinal Cord Injuries
• Scoliosis
• Infantile Disorders
• Learning Disabilities
• Chronic Fatigue
• Emotional Difficulties
• Stress and Tension-Related Problems
• Fibromyalgia and other Connective-Tissue Disorders
• Temporomandibular Joint Syndrome (TMJ)
• Neurovascular or Immune Disorders
• Post-Traumatic Stress Disorder
• Post-Surgical Dysfunction

SomatoEmotional Release (SER) is a therapeutic process that uses and expands on the principles of CranioSacral Therapy to help rid the mind and body of the residual effects of trauma.”

Sometimes difficult memories created under stress cause a restriction that is trapped in the connective tissue. When these restrictions are released the memory is also released and may let go in an emotional wave that may be as vividly painful as when the memory was first created. However, you also have the realization that you are safe now, the actual trauma is past and it’s OK to let go of the memory. Sometimes passive muscles react to the signals and stretch and twist and turn to further improve the flow of lymphatic fluid. You might feel that your body has taken on a mind of its own, moving with unknown intent or purpose. You might walk away feeling like you have had an internal massage, you might feel out of balance, not realizing you may have walked in out of balance and might be leaving more attune with yourself.

 How does CranioSacral Therapy Work?
According to Dr. Upledger, the central nervous system is heavily influenced by the craniosacral system – the membranes and fluid that surround, protect and nourish the brain and spinal cord. Every day stresses and strains can cause body tissues to tighten and distort the craniosacral system. These distortions can then cause tension to form around the brain and spinal cord resulting in restrictions, similar to high blood pressure in the vascular system. This can create a barrier to the healthy performance of the central nervous system, and potentially every other system it interacts with. With a light touch, the CST practitioner uses his or her hands to evaluate the craniosacral system by gently feeling various locations of the body to test for the ease of motion and rhythm of the cerebrospinal fluid pulsing around the brain and spinal cord. Soft-touch techniques are then used to release restrictions in any tissues influencing the craniosacral system. For more information on craniosacral therapy, or to find a craniosacral therapist near you to go to:  www.upledger.com

What is Reflexology?

Reflexology is a form of bodywork that focuses primarily on the feet. The underlying theory behind Reflexology is that there are "reflex" areas on the feet and hands that correspond to specific organs, glands, and other parts of the body. It’s based on the premise that all nerves of the spinal cord connect from the top of the head to the feet. The toes reflect the head, the ball of the foot reflects the heart and chest, the arch of the foot the liver, pancreas, and kidney, etc.

Early Practitioners believed that applying pressure to these reflex areas could promote health in the corresponding organs through energetic pathways. Dr. William H. Fitzgerald, an ear, nose and throat physician introduced this concept in 1915. Eunice Ingram, a physiotherapist further developed it in the 1930's into what is called Reflexology. More recently, Dr Jesus Manzanares has established the neurophysiological basis of reflexology. His work has demonstrated that deposits that are being rubbed out on the feet have a higher nerve fiber and vascular element than similar appearing hypodermis level deposits. His research has further defined the communication pathways involved in Reflexology. To learn more about his work go to www.manzanaresmethod.com

I went to Reflexology because I was frustrated with my Asthma and my dependence on inhalers. My chest felt congested most of the time, with a constant awareness of decreased lung capacity. I had been trying to exercise but I needed to be able to breath better to exercise. My body felt disconnected. I really wanted this treatment to work, as my therapist was rubbing on my feet I tried to figure out which organ connection she was rubbing on based on the sensations in my body. I could identify when she hit the zone for my lungs because I inadvertently took a deep breath that seemed free of restriction. I could tell when she was working on my pelvis because I would get a muscle spasm that would ripple through my abdomen, it felt like an internal stretching or flexing of unknown muscles and tissues, an unwinding of a knot. With each session I became more aware of the internal workings of my body. I always left a session feeling very relaxed like I had just had a warm internal shower, relaxed and content but revitalized. In one session my therapist was rubbing on the inside edge of my foot, in a new area, and she said “I just went to a seminar and learned something new; did you have a trauma 12 years ago, maybe a car accident?” I said, “No, never been in a serious car accident..” As soon as the words were out I felt propelled into the past, and I was sitting in my car white knuckling the steering wheel, feeling like I wanted to scream, driving to work at 10:30pm very unhappy with my life. I was thinking, “my stress level is at a 9.5/10 and I don’t know how to fix it.” I was very frustrated and disappointed in myself; “Why couldn’t I deal better with my situation?” I was working 50-60 hours a week rotating days and nights, my husband was unemployed, we were remodeling our house, I had 3 small children plus a foster child, and 6 people were sleeping in 2 rooms. I suddenly realized that anyone in that situation would have probably felt stressed and I was not deficient for having a hard time dealing with it. I could suddenly appreciate that anyone might feel out of control in this situation. As I “forgave” myself for my feelings of inadequacy, the dream evaporated and so did the stress. Poof it was gone, I felt over exposed, raw, but cleansed. My therapist was unaware of where my mind had been, and the stress that was released, she was still rubbing my feet.

I’ve been told that Reflexology can open nerve connections, remove blockages, and sluggish communication between the brain and internal organs. I’ve been told that we can store emotional dilemmas in our connective tissue, like scar tissue or a cyst, so we don’t have to maintain it in the forefront of our minds. In my mind I can imagine that Reflexology can find these scars or cysts and free them at a time when we are safe in our current situation and have the ability to realize that it’s OK to let them go. Reflexology leaves behind an increased awareness of who I am; an increased connection to the internal workings of my body. It feels like I’ve checked in with my organs and tissues and fine- tuned the electrical system of my body. To find a Reflexologist in your area go to www.integratedreflexologistsofwi.org

What is Functional Medicine?

What if labeling symptoms with a diagnosis code sometimes prevents us from digging deeper to find the real issues? 

Once the disease is labeled we continue to treat the symptoms according to algorithms and treatment plans. I think illness is more individualized than that and spending time investigating the beginning can prevent wasted resources and time. For example, a woman goes to her doctor with high blood pressure, labs and diagnostic tests come out normal. She is given an antihypertensive medication to bring down her blood pressure. What if her blood pressure is elevated because her husband filed for divorce, her son is taking drugs, she is filing bankruptcy, and has a history of poor nutrition. She is losing her ability to cope. The antihypertensive pill may lower her blood pressure but it really isn’t fixing the underlying cause of her high blood pressure.

“Functional Medicine is a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease”, according to Dr. David Jones and Sheila Quinn from the Institute for Functional Medicine.  They go on to say, “Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long term health and complex, chronic disease.” Functional medicine is looking at the whole person, putting together a time line of events that may have affected overall health and focusing on a treatment plan that treats current disease as well as working to prevent future health problems.   

 Functional medicine suggests that there are many factors affecting health including Nutrition, Sedentary lifestyle, chronic stress, poverty/uninsured, environmental toxicity, indoor living, and an aging population. Functional medicine aims at integrating the science of medicine with the art of clinical practice. It works to restore balance in the complex adaptive system that is the human being.

The Human body has several built in back up mechanisms. We use calcium to relax heart and other muscle, for bone strength, and we can use it as a buffer in digestion. The body can pull mineral stores from many internal sources to satisfy the body’s needs. Imagine that our brain prioritizes where vitamins and minerals are utilized based on critical need. It would make sense that a lack of calcium might affect muscle relaxation, our ability to buffer acid in our stomach and cause brittle bones. A long term dietary deficiency of calcium might relate to indigestion, body aches and muscle cramps. Taking a drug for pain in this case might not be as beneficial as identifying dietary deficiencies, genetic history and assessing lifestyle. To further complicate this example, if we need Vitamin D to absorb calcium and we don’t have enough in our environment,  we might have enough calcium but a decreased ability to utilize it. The calcium deficiency may not be found in a blood test because the brain is regulating the supply of calcium and might find the calcium level of the blood to have a higher priority than calcium in the bone. 

Looking at the whole picture might better identify a timeline of when the body demonstrated it was losing it’s ability to cope and what deficiencies led to the problem. Identifying the cause and treating the true dysfunction might prevent a health problem from continuing to escalate, and prevent subsequent additional system failures. Functional medicine can go into great depth investigating environmental exposures, lifestyle influences, and genetic predispositions to determine an evolving plan of action as the body continues to adapt.

According to the Institute for Functional Medicine,

“Functional medicine is shaped by seven core principles:

1.    Acknowledging the biochemical individuality of each human being, based on concepts of genetic and environmental uniqueness.

2.    Incorporating a patient-centered rather than disease-centered approach to treatment.

3.    Seeking a dynamic balance among the internal and external factors in a patient’s body, mind, and spirit.

4.    Addressing the web-like interconnections of internal physiological factors.

5.    Identifying health as a positive vitality-not merely the absence of disease- and emphasizing those factors that encourage a vigorous physiology

6.    Promoting organ reserve as a means of enhancing health span, not just the life span, of each patient.

7.    Functional Medicine is a science-using profession.”

What Is Spiritual Health?

What is Spiritual Health?

Spiritual health is about coping and inner strength. Athletes have a pep talk prior to a game. We had pep rallies in high school, the whole assembly would show support and give our team energy for the game. Statistics show a correlation between how well a child does in school, and how much family support they receive. I was told as I was getting married not to forget my girlfriends, when life gets tough they will be there for you. Life doesn’t come with a guide book, babies aren’t born with an instruction manual. Life is designed to be a team sport, we turn to our mothers, grandmothers, girlfriends, sisters, brothers, fathers and friends. No two lives are the same, but challenges are similar and sometimes having someone tell you, “you are strong, you can do this”, is just what you need to get you to the next level, around that next corner. Each challenge won brings new strength and understanding. I admire multi-generational households where the grandparents can provide mental support and say “I’ve been there, done that, you have the strength and ability to get through this”. Children provide physical work and receive the satisfaction that they are valuable, important, and needed.  Having a co-worker say “nice job”, a pat on the back, a hug- can be priceless. Spiritual health is having someone to talk to for strength or guidance when faced with an overwhelming situation, external support from nature or creation. Where do you go to find strength?

Dr. Masaru Emoto in his book “The Hidden Messages in Water,” demonstrates how water molecules respond brilliantly to positive messages.  The human body is composed mostly of water; we should also demonstrate a positive physical response to supportive messages.

What if we don’t have any family, we don’t fit the part, we aren’t pretty, we aren’t good at sports. We don’t have friends, we lost the game, or we lost our job. We were born with a skin condition, we would rather be forgotten by society and ourselves.  What happens when high school is over, we move away, we trying to juggle work, marriage, children, home responsibilities and life. We don’t have time to take care of ourselves and the pressure is on.  Where do we derive spiritual support? 

My co-worker, a medical provider, doesn’t like prescribing narcotics for chronic pain. She’s made the observation that many of her chronic pain patients are lacking external support. They have multiple diagnoses, always come alone,  have many psychosocial complaints. They are consumed by their internal pain and obsessed with the workings of their body. They don’t know how to get outside of themselves. How many times is a pill used to treat a symptom of a bigger problem? What is really the best treatment? I wonder how much of our health care problem is related to treating symptoms and not finding more appropriate solutions. Are we over relying on medication to treat societal problems? 

John Kretzmann and John McKnight, from Northwestern University wrote a  fantastic workbook, “Building Communities From the Inside Out”. It is an excellent workbook. They suggest that “communities cannot be rebuilt by focusing on their needs, problems, and deficiencies. Rather, community building starts with locating the assets, skills, and capacities of residents, citizens, citizens’ associations, and local institutions.” Their workbook is packed with ideas for making connections within a community. They have a Capacity Inventory (pg 19) for helping individuals to identify their skills and talents. If you can walk, talk, hear, or see there is something you can do to support your community and give yourself feelings of self- worth and belonging. Everyone is valuable, sometimes we need to get outside of ourselves to realize that. If you want to build a playground, you find a group of passionate workers, citizens of the community, who will be invested in the project. Not only will they give the project their best effort to complete, but they will take care of it for years to come.

 Rob Bell, a motivational speaker, said the best job for a shy introvert, or someone lacking in feelings of self-worth, is to be a greeter or a bagger in a grocery store. You have to smile and say “Welcome”, people will inadvertently smile and say “Thank You” back. You have people smiling and saying “Thank You” all day long! He also gave me a business card, that says, “ I’m Alive, I’m Awake, and I Feel Great!” he said read this card when you wake up in the morning and you won’t go  back to sleep. 

Hospice does a Spiritual Assessment. They want to provide comprehensive care to meet all of your needs. They ask questions on spiritual awareness: feelings of abandonment, anger, faith, fear/anxiety, forgiveness issues, gratitude, grief, guilt/shame, hope, inner peace, joy, love, preparedness for death, questioning and trust. They want to know where you derive support, they understand that relationships are huge and life is a team sport. They encourage healing relationships.  

I visualize in our future, nurse case managers evaluating all the needs of our clients. Assessing their physical, mental and spiritual needs and providing direction on how to best meet those needs. It might include conventional medicine and pharmaceuticals but it might also include a deeper investigation into the underlying causes of the body’s dysfunction.  It might include skilled practitioners who know how to listen to the body to help it heal itself. Life is a team sport, health involves the whole community.

Importance of Behavioral Health

What If We Include Primary Care Behavioral Health?

It seems logical to me that we would all need psychological help at some point in our lives, if we have ever raised children, experienced divorce, sickness, loss of family members, had a change in job, or moved - we have experienced stress. If merely hearing some bad news can cause the body to leak fluid from our eyes, cause our face to swell, our chest to feel heavy with pressure, making it hard to breath, we might choke or vomit. How can we not believe that stress has physical ramifications? Couldn’t we expect that prolonged stress might have deeper long term damage?  It’s also logical to me that a chemical pill might ease my pain and provide some relief but I still need to figure out how to move forward in my life. In the case of acute crisis, help might include focusing on the present, “I am safe here and now, in this room, in this place”. Healing might include focusing on breathing; count to 3 when I inhale and count to 4 when I exhale. It might be approaching life in smaller pieces - focusing on minute to minute, or hour by hour, rather than day by day. It might include helping to recognize that we all behave differently under stress, and that our thoughts and emotions do not define who we are. 

Some patients get sick from having unhealthy behaviors, others stay sick because they can’t or won’t follow recommendations from their providers. Primary Care Behavioral Health (PCBH) in the clinic can investigate what is preventing patients from improving. PCBH can go into an office visit after the MD has completed his assessment to help draft a plan of care that takes into consideration a patient’s attitudes, beliefs and behaviors. PCBH investigates the patients coping ability, relationships, support, motivations, and ambitions. They use several assessment tools to maximize their time, so they can identify the roots of dysfunction and offer tools for dealing with them. They investigate ways of motivating patients to want to be healthy and they can assist a member in accepting Mental Health services more quickly. They may be able to increase the patient’s willingness to take responsibility for their health, and work with the provider toward optimal health. Patricia Robinson & Jeffrey Reiter in their book - Behavioral Consultation and Primary Care: A Guide to Integrating Services  - report that “up to 70% of Primary Care medical appointments are for problems stemming from psychosocial issues (Gatchel & Oordt, 2003).” They go on to say that “the use of psychotropic medications has gone up dramatically since the mid-1980s amongst all prescribers, and psychotropic medications are now among the most widely prescribed medications in the USA (Pincus et al.,1998).” The antipsychotic drug Abilify has the highest sales of any drug in America according to WebMD. 
Another benefit of PCBH is that their visits in a medical visit, not mental health visit, decreases the stigma of mental health services. Mental health has a large percentage of no show appointments and PCPs are often seeing patients for depression, anxiety and copying issues, when these patients might be better served by mental health. 

Life is a team sport and we all need a little help now and then. Hopefully when I’m down I have friends, family, or spiritual support to help me through this challenging period. PCBH can help define strengths and amplify them, problem solve challenges to deal with them, help me move forward toward a more fluid existence. Remember how it feels to be in love? My husband felt light as a feather, 20 years younger, stronger than a horse, his vision was clearer, hearing more acute, and sense of smell more vibrant; all because I said, “I love you, and I want to be with you”, simple little words. Let yourself feel the value of a smile, a “Good Job!” We all need to be reminded occasionally that challenging days will pass, and the sun will shine again. Help me to understand that others have been through similar pain and challenges, and survived. 

 If we understand the power of emotions and our psyche on health, then it makes sense to me that we need to listen and assess this to achieve Optimal health. When, I worked in the hospital, we expected the primary care provider in the clinic to manage the patients overall health and adjust the plan of care.  As a Home Health nurse, I averaged about 45 minutes per visit, 15 minutes to assess how my patient was feeling today, 15 minutes to evaluate their overall health and assess changes, and the last 15 minutes teaching and updating the plan of care.

 Primary care physicians have only 15-30 minutes total per visit with patients to manage their care, and they have the added disadvantage of seeing their patients out of their natural surroundings and up to 32 patients a day. I can’t understand how a primary care provider can review and assess response to medications, assess overall health, coping ability, diet, bodily functions, answer questions, and chart in a total of 15-30 minutes. Sadly, most providers will admit they can’t finish in 15 minutes so they focus on the top 2 questions, scan the information they have, make a rushed decision and chart after hours on most of their patients. Most of the primary care providers I know are spending at least 1-2 additional hours per day, charting on their own time, after hours or on their days off. Often they accept this as a requirement of the job. It’s a no win situation and it isn’t cost effective. I question if to make sure they aren’t missing anything, providers are ordering additional diagnostic tests including MRIs and CT scans. If providers had more time with patients, they might feel more comfortable watching and waiting to see if patients improve in a few days. If health care is our highest cost expense in the US shouldn’t we be able to expect more as providers and as patients? To put this into perspective, we value our property so much that we pay taxes to have fire and police protection available when needed for as long as it takes to get the job done.  Property is replaceable, the human body = one per person for life! 

Primary Care Behavioral Health is partially designed to address this issue of not enough time to thoroughly evaluate patients. If the problem is at least partially stress induced wouldn’t it make sense to try to remove or treat the stress variable and see if the physical symptoms resolve? Optimal Health Care involves a team approach; no single provider can meet the needs of all of our patients. Working with the strengths of each other, we create a win –win situation for everyone which is more cost effective for the providers, the patient, and the insurance company. 

Nurses provide an important role, by triaging the background of the patient’s problems before the office visit. Nurses can organize service providers to increase efficiency and facilitate comprehensive holistic care for our patients.  

For more information on Primary Care Behavior Health go to:

www.Primarycareshrink.com

www.integration.SAMHSA.gov

www.DrArmandoHernandez.com – Thank you to Dr. Hernandez for your inspiration and resources.

What If It's About Attitude?

What if it’s about Attitude?

When I go to work I leave my personal belongings and my personal life in my car. When I get on the phone with my patient it’s all about them. Why are they calling? What’s really the problem? 

I’m listening to the tone of their voice, back ground noises, and what’s beyond their words. My attitude is I want to help you. I know that if my intentions are good, my words and actions will follow. Over 90% of my patients are stressed. I try to hear what they are saying, knowing that if they are angry or upset their words are often not the whole story. Why are they frustrated and hurting? Often they are losing their ability to cope. They need help and they’re scared. They are losing control. 

I want to get to the root of their problem. I need them to trust me and talk to me. Often they don’t know what they need, I try to help them figure out what they are trying to say. When did you first notice this problem? How did it start? Often a problem doesn’t have a clear starting point, then I look for a gradual progression to the problem: stress that won’t let up, repetitive work or activity. Emotional and mental stress can often lead to physical breakdown. My best friend swears she developed breast cancer due to working in child welfare and having to take children away from their parents. The emotional pain traumatized her “motherhood”. I would swear I developed appendicitis due to being scheduled to work Christmas Eve and Christmas Day at both my jobs while raising a young family. I was stressed to my “core”. As health care providers we try to help our patients identify what’s really wrong. It’s our responsibility to encourage them to want to get better. It’s my goal to give them hope, to see a little light at the end of the tunnel.
“Look what you’ve already accomplished, here’s the next steps.” “Can you see the light at the end of the tunnel? You can get through this.”

Sometimes it’s all about Attitude. I want them to be well. Sometimes they just need to believe someone cares. They need the tools, strength and motivation to get better and they need to take responsibility to do their part in getting well. It’s my responsibility to teach and offer resources. It’s their choice whether they accept my help and  what actions they will take. 

Group Health Cooperative has Primary Care Behavioral Health in their clinics. When I first heard about this I thought, “How am I going to work with Mental Health?” I can appreciate that Behavioral Health workers in the clinic with primary care, could be handy in cases of depression or anxiety or with patients whose health was complicated by other mental health diagnoses. At first, I wasn’t sure how to utilize them. However, over the first year of having them available I’ve come to realize that every diagnosis carries a behavioral component. Now, it seems like an incredibly bright and insightful idea, it’s progressive and important, a step in the right direction. Anytime a patient is not improving, needs more time to talk, or needs help coping, we send them in. Our behaviors and choices affect the food we eat, our stress, our compliance, the risks we take. Our attitude and behavior is a reflection of our sense of personal responsibility.  Often whether we are sick or well, can be a matter of value and self -respect. Sometimes patients need help to find a reason to care. What’s your motivation?

I took care of a young mother in the hospital who had lung cancer. She was smoking 2 packs of cigarettes a day. She loved her children, her husband,  and cigarettes – in that order. She was a very strong and independent woman. She came in for surgery, stayed a few days and went home. We of course told her to quit smoking but she refused. She loved smoking, it was part of who she was. About 6 months later she was back, the cancer was back, and she had pneumonia. She was still a really tough woman; I admired her strength, independence, and determination. She said “This cancer will not kill me, I will beat it, I will not leave my children without a mother”. She was very ill and we were giving her chemo and antibiotics. She was getting so much fluid that she developed generalized edema and her arms, hands, and fingers looked like huge sausages. Her lab values were deteriorating, she was told she had a 50/50 chance of living and the doctor wanted to stop the chemo. She said, “No, I can take it”.  She continued to decline. I called the doctor around 2am on the night shift and said I was worried about her, she was retaining so much fluid and I couldn’t watch her all the time since I had a full load of patients on my medical unit. He transferred her to the ICU. When she left my unit, I was sure she wasn’t going to make it, I was sure I would never see her again. I couldn’t imagine how anyone who was so fluid overloaded, and had so much against her could survive. She continued to decline and was given less than a 20% chance of survival, she was intubated and continued to decline. The doctors pressured her husband to make her a No Code. 

He eventually, reluctantly, agreed. Somehow, in the middle of the night she woke up enough to extubate herself and she lived. She walked out of the hospital a few days later. She did stop smoking. She came back to visit a few months later and brought us baby Jade plants. I was pleased but embarrassed to see her, I had given up on her before she was ready to give up on herself.

She taught me to never give up on my patients until they are ready to quit trying. It’s my job to keep working, searching, and trying until my patients say they are ready to quit. I was working in Palliative Care at the hospital and one of my patients was a Catholic Priest. He had been non-responsive for a couple of weeks, there was a nun who frequently visited and cared for him. I was wondering how much longer he could hold on. She said, “I bet he makes it to Palm Sunday, it was his favorite Mass”. He died on Palm Sunday at 11am, She said, “Just in time to celebrate Mass with Jesus.”