Let’s talk about your emotional health

DSC00585

Your emotional wellbeing is an essential part of your health, but many patients only see their doctors when something is wrong with their bodies.

In the daily reality of my family practice, I assist patients coping with overwhelming emotions, troublesome thoughts and anxiety. Many initially present a physical problem, such as abdominal pain or insomnia as the reason for the visit.

Physical problems themselves are a cause of distress and can have a significant impact on our lives. Yet emotional distress can result in even greater negative effects.

Our emotional states can narrow our thoughts and influence our behaviour, affecting our enjoyment of life, our performance at work or in school, and how we relate to others. This can create vicious cycles of distressing emotional states, negative or anxious thinking, and worsening of our circumstances that in turn leads to increasingly negative feelings.

Our feelings shape our thoughts. When anxious, we may see a more threatening, overwhelming and unpredictable world. We underestimate our ability to cope. We overestimate what we must deal with.

When we become depressed, we may see our selves, others and our circumstances in a negative light. We have more difficulty seeing our own good qualities and abilities, the good in our relationships and the positive aspects of our circumstances.

Many people suffering from emotional symptoms hesitate to get help because they think they should be able to manage on their own. Although normal emotional reactions are part of life – it’s human to feel sad if we lose a loved one and anxious when we’re threatened, we need help when our emotions are of an intensity and duration such that they negatively impact the important areas of our lives, including our relationships and our performance at school or work.

Family members and friends sometimes don’t know what to do when someone they care about is suffering emotionally. Some mistake depression for a minor case of the blues that we all suffer when things don’t go our way, but people with depression can’t just snap out of it.

They need more information on how to recognize serious emotional problems and how to get help.

The Doctors of BC (British Columbia Medical Association) has just launched a new website, OpenMindBC.ca as part of its Council on Health Promotion Youth Mental Health Project. It contains valuable links to resources for youth and young adult patients and families, teachers and health care providers.

You’ll find information about common emotional problems, including anxiety, depression, substance abuse and psychosis. On the site, you can find online tools for self-assessment, practical self-help information, tips for managing stress and information to access professional help.

Even if you’re neither a youth nor a young adult, check out this invaluable website anyway. You’ll find helpful suggestions that anyone can use to manage stress and maintain emotional health.

And if you need some help with your emotional health, talk to your family doctor. It’s part of what we do to care for you as a whole person.

Dr. Davidicus Wong is a family physician. 

Posted in Caregiving, Emotions | Tagged , , , , , , , , | Leave a comment

Self-Care is Healthcare

icebergImagine an iceberg. All that we see is the fraction above the surface, but 90% of its bulk lies in the depths of the ocean.

In healthcare, most of our attention is drawn to acute hospital care with less given to the bulk of care within the community: in ambulatory clinics, primary care practices, residential and home care.

But really, who provides over 90% of your healthcare? Hint: It’s not doctors, nurses and other healthcare professionals. Where do actions have the greatest impact on your present and future health?

Your personal medical and family histories are important in identifying particular areas of your health that demand special attention. Yet by far the greatest predictor of your health tomorrow are the habits you practice today.

Some bad habits and their negative effects on our health are obvious. Smoking shortens life and its quality through accelerated atherosclerosis (narrowing and progressive damage to our blood vessels) thereby increasing our risks for premature dementia, strokes, heart attacks and kidney disease. It increases the risk for cancers including the lung, oral cavity, throat and bladder. It progressively damages the lungs, leading to emphysema or chronic lung disease.

Excessive alcohol (more than two or three drinks on any day) contributes to high blood pressure, progressive liver damage (leading to cirrhosis and liver failure), ulcers and impairment in the quality of work, social and family life.

Mood and mind altering street drugs, including marijuana, lead to dependence and addiction. They are a form of chemical coping – similar to the use of short-acting prescription tranquilizers and sedatives. They are ultimately disempowering; they take away one’s sense of control over one’s own life, body and emotions. Drug and alcohol dependence impairs mood, judgment, driving safety, work, school and relationships.

The quality of your daily lifestyle is a powerful predictor of your future health. You really are what you eat. What you consume provides the energy and building blocks for the cells and organs of your body. You wouldn’t build a car with defective parts and fill the tank with contaminated fuel.

For most of us, our bodies thrive on a variety of fruits and vegetables, which provide the vitamins and anti-oxidants we need for healthy cellular function. We need adequate protein to rebuild and repair muscles and other tissues. We also need adequate but not excessive calories and fats (such as fish oils) in our diet. In general, we should avoid excessive animal fat and processed food.

If you haven’t put too much thought into what you eat, take the healthy eating challenge. See how much better you feel with a month of more mindful eating. Over the long term, healthy eating reduces obesity, high blood pressure, kidney disease, diabetes, heart disease and strokes.

Three other key areas of self-care are (1) physical activity, (2) emotional management and (3) healthy relationships. These will be the focus of upcoming columns that will include practical tips to achieve your goals in healthier daily living.

Dr. Davidicus Wong will be speaking on self-care at the Bob Prittie (Metrotown) Branch of the Burnaby Public Library on October 20th. Register by phone at (604)436-5400 or online at www.bpl.bc.ca/events. You can read more about achieving your positive potential in health at davidicuswong.wordpress.com.

Posted in Balance, Burnaby Division of Family Practice, Empowering Healthcare, Exercise, Healthy Living | Tagged , , , , , , , | Leave a comment

Are you an introvert or an extrovert?

Central Park, Burnaby by Davidicus Wong

Central Park, Burnaby by Davidicus Wong

September is a month of anticipation, relief and anxiety. It depends on who you are (student, parent or teacher) and where you fall in the spectrum of introversion and extroversion.

An introverted child may find new teachers, group activities and speaking out in class incredibly uncomfortable and daunting. In fact, some parents choose to homeschool because of this.

Our place along the continuum of introversion and extroversion seems to be a hardwired aspect of personality and physiology. Although many are somewhere between the extremes of introversion and extroversion, at least a third of the people you know are introverted.

If you’re introverted, you may prefer reading a book at home to going out to a party. You need to reflect before you speak, and you may find social interactions with multiple people emotionally draining. You need time alone to recharge your batteries.

Extroverts on the other hand thrive on social interaction and in fact are energized by people. They may need to express themselves in order to figure out what they’re thinking.

In her bestseller, “Quiet: the Power of Introverts in a World That Can’t Stop Talking”, Susan Cain outlines the neuroscience, psychology and sociology that explains the differences and relative strengths and gifts of introverts and extroverts.

She describes how our western society is biased towards an Extrovert Ideal. We favour charismatic leaders, people who speak out and control meetings, and the gregarious and outgoing.

Our classrooms and workplaces often favour extroverts who feel more comfortable working in groups and shouting out the answers to the teacher’s questions.

Beautifully written and researched, Cain’s book is a must read for teachers, employers, parents and partners of introverts. It will change the way you see and value introverts, and if you’re an introvert, it will change how you see yourself.

In workplaces with an open office design without privacy, more introverted employees will be more uncomfortable and less productive. If an organization relies on group brainstorming meetings, they may not hear the creative insights of the more introverted who do some of their best work alone.

In the classroom, group activities do not bring the best out of more introverted students. The brightest are not always the first to press the buzzer.

Susan Cain’s book offers practical advice for introverts on self-acceptance and appreciation, understanding extroverts with whom they live and work, when to act more extroverted, and the importance of finding restorative niches to recharge themselves.

The marriage of an introvert and extrovert can be both challenging and rewarding. Extroverts may say things they don’t mean and thrive on conflict; introverts can be more sensitive to their words. Each partner needs to understand how the other needs solitude or social engagement. Cain offers insights to improve mutual understanding and honouring one another’s natures.

Our society is enriched by a variety of cultures, temperaments and personalities. Introverts have great ideas, feelings and insights to share, and with better understanding, we can nurture their strengths at school, at work and at home.

Dr. Davidicus Wong is a family physician. 

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The measure of your day

The Pool at Central Park, Burnaby

The Pool at Central Park, Burnaby

Is today just another day?

And tonight after it has passed, will it be forgotten?

Is it a day in the way? That’s a countdown day that you just want to get through because it stands between you and what you anticipate – a special day in the future, a holiday or the weekend.

In the trance of everyday life, we can get caught up with nonstop activity, endless goals and distractions. We lose sight of what matters most, and we can forget a simple truth.

Every moment is precious and every day a gift.

When they were young, I taught my children to frame each day.

Before they rolled out of bed, I asked them to say a prayer of thanks, considering all the good in their lives, especially the people they loved. By beginning the day with their cups half full, they would be more inclined to see the positive throughout each day, and when their cups were full, they would be more likely to share and give.

Again at the end of each day, at suppertime and at bedtime, they would recall the gifts of the day: what they enjoyed, what they received and what they gave.

This summer, my kids are asleep when I leave the house and they’re awake when I go to bed. I no longer keep track of their prayers, and I wonder if they like most grownups and teens have become too busy to frame their days and measure their moments day by day.

Most physicians experience a nearly constant pressure of time. While looking after our patients, there are always competing demands on our time. And outside of clinical time, we may be on call, attending endless committee meetings or managing a perpetual pile of forms and reports.

I must confess that every one of my days – like an overstuffed suitcase – is packed with activity. I sometimes judge the day by how much I have accomplished: A good day is a productive day.

But none of us should wait until the next holiday, retirement, or the end of life, to wake up and live each day.

We should begin – and continue – with the end in mind.

To not waste a day does not mean to pack it full of activity.

We waste this day by not being fully awake.

What gives your life meaning? Are you awake to the experience of being alive – tasting, touching, breathing, feeling?

What are your greatest goals? What are you doing with your time?

What are you doing this day to take one small step in the direction of your dreams?

Today are you talking to the people who matter most? Are you fully present in the presence of others?

The measure of each day is like the measure of our lives, and the unit of measure is love.

How have you shared love this day? Be gracious when receiving it. Be generous in expressing it.

How were you helped in big and small ways, and how are you helping others?

Don’t let this day slip by as another blur of time, another square on the calendar or another countdown day.

Make it count.

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Three keys to a better hospital stay

Prague Castle

What happens if you try to run in a hospital gown (Prague Castle)

If you’re admitted to a hospital, you may lose your sense of control over your own healthcare.

You’re expected to wear a gown instead of your own clothes. Many people pop into your room unannounced, and they write notes in a chart that you can’t see. You may be given medications but not know what they are for, and sometimes, you may not know who is making decisions for you.

Yet autonomy is a cornerstone of medical ethics. Capable patients must be sufficiently informed in order to make the best decisions for their own care.

When you visit a physician, nothing is done without your consent. After listening to your concerns, asking more questions and performing an examination, the physician will offer a working diagnosis and suggest some options for investigation or treatment.

In order to make informed decisions, you need four key pieces of information: (1) the purpose or reason for the treatment or investigation, (2) the common side effects or risks, (3) the serious, including life-threatening, side effects or risks, and (4) alternatives to the proposed treatment or investigation.

Here are three keys to improving your hospital experience.

  1. Stay in control. If you are capable of understanding your situation and treatment options, you should continue to make important decisions about your care in the hospital. Ask the four key questions for any proposed treatment or investigation.

Ideally, you should express your wishes before you find yourself in the hospital. Consider writing an advanced medical directive. If you become ill or incapacitated, what types of treatment would you want? If you were no longer capable of making your own decisions, whom would you entrust to make decisions on your behalf? Discussing these issues ahead of time will make things easier for your family and will make it more likely that your wishes will be respected.

  1. Know the team. There are so many people working in the hospital that many patients don’t know who is who. It doesn’t help that many health care workers wear surgical scrubs (or “greens”) and white lab coats.

What could be easier than getting up and changing from comfy pink sleeping pajamas to comfy green pajamas? If we all did this, no one would buy pajama jeans.

You could try to read the nametags, but if you’re not sure, don’t be shy. Ask for each person’s name and their role (i.e. nurse, respiratory technician, pharmacist, dietician or doctor). If it’s a doctor, what is their specialty (i.e. internal medicine, hospitalist or surgeon)?

Most importantly, you need to know who is the “attending physician” or “most responsible physician.” This is the physician who is directing your care throughout your hospital stay. It is possible that this might change from day to day which of course is less than ideal.

  1. Set up a channel of communication with your attending physician. Some hospitals have white boards in every patient’s room indicating the plan or schedule of tests or procedures, the results of tests and the expected length of the hospital stay.

If this isn’t the case, you should have a large pad of paper at your bedside so that this information could be written down for you. You should prepare your own list of questions for your doctor. Try to find out when that doctor is expected.

Like the traveller forcing himself to stay awake on the plane so he won’t miss his meal, patients dread falling asleep and missing the doctor during daily rounds.

I’m hoping you won’t find yourself or your loved ones in the hospital any time soon, but if you do, follow these three steps to maintain control of your care.

 

 

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Posted in Empowering Healthcare, Medical Ethics, patient-doctor relationship, Uncategorized | Tagged , , , , | Leave a comment

The Lonely Patient’s Guide to Your Hospital Adventure

 

Prague

Prague

I’m writing this in my hotel room in the Old Town of Prague.

In this ancient city of a hundred spires I’m surrounded by wonder and beauty, but in a place so different from home, I’m reminded that I’m a traveller in a land that is strange to me. Along with the adventure of new sights, sounds and experiences, comes a subtle discomfort with the unfamiliar and the potential for danger.

It is not unlike the experiences of my own patients, friends and family who have found them selves in another strange place – the hospital.

A big difference between travelling to another country and finding yourself in a hospital is the surprise and misadventure that brings you to the latter. It’s like being a refugee fleeing from disaster rather than a vacationer to the happiest place on earth.

As a patient, you might feel like Dorothy being swept to the Land of Oz, and I don’t mean Australia.

You might end up in the hospital for a procedure such as an operation, which many times can be planned and expected. In this case, it’s almost like a pre-booked holiday (perhaps with a very long wait) and the length of your stay is usually predictable.

Most patients, however, are unexpectedly admitted to the hospital in response to an accident (e.g. a fall with a fractured hip) or an illness (e.g. infection, stroke, heart attack or symptoms of an as yet undiagnosed condition).

The goal for most patients admitted to the hospital of course is health – having undergone a successful operation, illuminating investigations or therapies that allow you to leave the hospital not only stable but healthy – or at least healthier than when you came in.

The not-so-secret secret is that hospitals can be dangerous places, and we’ve all heard stories of patients getting sicker due to medical misadventure, mistakes that weren’t picked up, unnecessary delays and hospital-acquired infections.

This is the reality when you gather many sick people in a large institution where every patient comes in contact with numerous health care workers. Fortunately, the vast majority of patients do well in the hospital and not only survive but thrive.

Since Hippocrates, the first rule of medicine has been to do no harm. Hospitals and health authorities are actively doing their best to reduce patient risks. Safety has been part of the new culture of health care.

Though patients are not to blame when things go wrong in the hospital, I’ll offer in my next column some key tips in being a more assertive patient or advocate for a friend or family member. In fact, I could write a whole book – or like travel writer, Rick Steves, a whole series of books on hospitals around the world; maybe the Lonely Patient’s Guides to Surviving Your Medical Adventures.

I’m writing this in my hotel room in the Old Town of Prague.In this ancient city of a hundred spires I’m surrounded by wonder and beauty, but in a place so different from home, I’m reminded that I’m a traveller in a land that is strange to me. Along with the adventure of new sights, sounds and experiences, comes a subtle discomfort with the unfamiliar and the potential for danger.

It is not unlike the experiences of my own patients, friends and family who have found them selves in another strange place – the hospital.

A big difference between travelling to another country and finding yourself in a hospital is the surprise and misadventure that brings you to the latter. It’s like being a refugee fleeing from disaster rather than a vacationer to the happiest place on earth.

As a patient, you might feel like Dorothy being swept to the Land of Oz, and I don’t mean Australia.

You might end up in the hospital for a procedure such as an operation, which many times can be planned and expected. In this case, it’s almost like a pre-booked holiday (perhaps with a very long wait) and the length of your stay is usually predictable.

Most patients, however, are unexpectedly admitted to the hospital in response to an accident (e.g. a fall with a fractured hip) or an illness (e.g. infection, stroke, heart attack or symptoms of an as yet undiagnosed condition).

The goal for most patients admitted to the hospital of course is health – having undergone a successful operation, illuminating investigations or therapies that allow you to leave the hospital not only stable but healthy – or at least healthier than when you came in.

The not-so-secret secret is that hospitals can be dangerous places, and we’ve all heard stories of patients getting sicker due to medical misadventure, mistakes that weren’t picked up, unnecessary delays and hospital-acquired infections.

This is the reality when you gather many sick people in a large institution where every patient comes in contact with numerous health care workers. Fortunately, the vast majority of patients do well in the hospital and not only survive but thrive.

Since Hippocrates, the first rule of medicine has been to do no harm. Hospitals and health authorities are actively doing their best to reduce patient risks. Safety has been part of the new culture of health care.

Though patients are not to blame when things go wrong in the hospital, I’ll offer in my next column some key tips in being a more assertive patient or advocate for a friend or family member. In fact, I could write a whole book – or like travel writer, Rick Steves, a whole series of books on hospitals around the world; maybe the Lonely Patient’s Guides to Surviving Your Medical Adventures.

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Healthier way to see yourself

Parliament Building, Budapest, Hungary

Parliament Building, Budapest, Hungary

In high school, my friend, Stan and I were amateur psychologists. He would introduce his latest categorization of people by saying, “There are two kinds of people in the world.” For example, there are those who see the cup as half full (optimists) and others who see it as half empty (pessimists).

The exceptionally joyful see the cup as overflowing, and the extremely negative see that cup as chipped, stained and half emptied of dirty, bitter scum.

After far too many categorizations, I had the final word. There are two kinds of people in the world: those who think there are two kinds of people, and those who don’t.

In her book, Mindset: the new psychology of success, Carol Dweck, an expert in motivation and personality psychology, describes two types of mindsets.

With the fixed mindset, we see our abilities as limited and stable. With the growth mindset, we recognize that we can improve our abilities and develop our talents over time.

This has implications in every aspect of our lives, including parenting, teaching, coaching and relationships.

As parents we might label one child the creative one and another the shy one as if their talents and personalities were permanent. These labels are often internalized and the child may come to believe in their limitations.

You might think of yourself as not creative, fearful of public speaking or never good at math and with a fixed mindset, never see yourself becoming more artistic or musical with training and practice, challenging and overcoming your fears, and learning to be both skilled and comfortable with numbers.

A growth mindset recognizes possibilities and potentials. It fosters hope and can motivate us to learn, practice and improve. Just because this is how we have been doesn’t mean we will always remain the same. We can grow – at any age.

Not only can a mindset shade how you see yourself and others, it can limit your relationships. Family members can fall into habits of behaviour, replaying the same interactions and seeing one another as caricatures of their whole selves. Over time, they don’t expect to see any improvement, so they don’t even work to improve their relationships.

A growth mindset with respect to relationships recognizes the potential to improve communication and foster the evolution of each relationship.

Consider how you have come to see yourself, others and your world. Have you been limiting yourself and your relationships through a fixed mindset? In what areas of your life do you see the possibility of further growth?

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Posted in Growth, Positive Change, Positive Potential | 1 Comment