Archive for April, 2019

April 29, 2019

Out of the Mouth of Babes, Snakes, and Scientists – Smell Begins With the Tongue

Sometimes a new idea comes out of the mouth of babes, snakes, and scientists. A study published last week online in advance of the print edition in Oxford Academic Chemical Senses finds that smell may begin with the tongue rather than the brain. One of the study’s authors, Mehmet Hakan Ozdener, MD, PhD, MPH, became intrigued with the idea when his adolescent son asked whether snakes stick their tongues out in order to smell.
tongue
A current model of taste and smell shows two genetically different receptor systems located in anatomically distinct locations that send signals to different targets. While the two are known to intertwine to form the perception of flavor, scientists thought that the first merger occurred in the insular cortex – a part of the cerebral cortex in the brain. The insulae are believed to play a role in functions that include perception, motor control, self-awareness, cognitive functioning and interpersonal experience.

The abstract of this new study states: “Here we report that olfactory receptors are functionally expressed in taste papillae…The results provide the first direct evidence of the presence of functional olfactory receptors in mammalian taste cells. Our results also demonstrate that the initial integration of gustatory and olfactory information may occur as early as the taste receptor cells.” (1) Other experiments confirm that smell and taste receptors may be found within the same cell.

There are 400 different types of functional human olfactory receptors and scientists do not know what molecules activate the vast majority of them. While fascinating, this study alone does not answer that question or have a practical application other than to advance knowledge that will lead to other studies.

That’s the beauty of science. It’s a living body of changing knowledge. One layer builds on another. The more we understand about how things work, the more options we have for enhancing our lives. It’s good to remind ourselves of that occasionally.

Believing science has become a battle cry among those who want to stand firm on what we currently know. There’s a danger in that because tomorrow we will know more and that may mean that what we know today is no longer supported by the evidence. It also makes science sound like a restrictive rule book. Who wants to learn a bunch of rules? Certainly not bright minds that can imagine big ideas.

Instead of believing science, I’d rather we love it! And while we’re loving it, let’s be curious. Curiosity leads to advancement. Questioning is good. Skepticism can play a valuable role. Allowing our understanding to shift and change does not threaten our way of life. It has the potential to vastly improve it.

But don’t take that from me, take it from the mouth of a scientist: “I have no special talents. I am only passionately curious.” – Albert Einstein.

(1)https://academic.oup.com/chemse/advance-article-abstract/doi/10.1093/chemse/bjz019/5470701?redirectedFrom=fulltext

https://www.sciencedaily.com/releases/2019/04/190424083405.htm

https://encyclopedia.thefreedictionary.com/insular+cortex
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April 23, 2019

Treasures Among the Trash

recipeYou never know what treasures you’ll find among the trash when you begin to clean out clutter. I’m sure the reason most of us have clutter is that we think too many things are treasures. Marie Kondo is making sure we know how to see the difference. But when we clean out an incapacitated or deceased relative’s home, we don’t have the luxury of choosing what is saved. We only have the opportunity to discover treasures among the trash.

Every month or two I spend a couple of days in my 98-year-old cousin’s house cleaning out the compilation of trash and treasure that includes: bank records from 1972, unopened mail from 1987, family photos from 1896, report cards from 1910, a wedding invitation from 1919, and a baby book from 1920. Because these items are mixed in with junk mail, decaying candy, promotional products, and wadded Kleenex, it is an arduous and sometimes icky process. I love it when I find some treasure that makes the effort worth it!

Recently, I’ve been working my way through the den toward the kitchen. Kitchens have the best variety of memorabilia. A few years ago, I discovered my grandmother’s ceramic green pepper spoon rest in my mom’s kitchen. I was thrilled. Now it’s on my counter by the stove. I love that visual reminder of my grandmother.
pepper
I also love finding old recipe cards. Not only do they give me a chance to prepare my favorite family dishes, there’s something charming about the varying shapes, sizes, and legibility of old recipes. Some assume you are extremely knowledgable about cooking techniques. Some have an ingredient list. Some do not. Many are spattered with remnants of food. Some are in handwriting I recognize. Some have clearly been handled more than others.

This look into the past seems more enticing to me than an old photograph or a tarnished silver service. Perhaps it’s because the recipes are a living memory. They can be created again and again. They can be shared with generation after generation along with stories of previous times they were enjoyed! If you think your kids don’t appreciate those stories, tell them to your grandkids.

At 2-and-a-half, JD loves any story about my experiences; he asks me to repeat them over and over. He never tires of hearing the details again and again. Adding food into the mix creates an indelible experience that he will no doubt share with his children and grandchildren. The recipe cards may not be preserved, but hopefully the recipes will find their way into his heart and his smart appliances or voice-activated replicator or whatever generates food in 2077.

Experimenting with unfamiliar flavor combinations is fun for me, but when I’m tired and hungry or it’s my birthday I’ll take my grandmother’s beef and noodles and a lemon meringue pie any day. Throw in some fresh green beans with new potatoes and I can smell the dirt from the garden when I helped my grandmother dig potatoes. These memories bring with them a sense of belonging to my family and to the earth. I had a place and a purpose.
pie
Such simple things can have a large and lasting effect. In this era of disconnection and short attention spans, we are often lacking a feeling of belonging and purpose. If you can provide that for your family by sharing the stories and food that you loved, is time spent in the garden or the kitchen worth it? I think so! I know time spent connecting is.

https://konmari.com/

https://ideas.ted.com/finding-our-way-to-true-belonging/

http://www.cooking2thrive.com/blog/the-benefits-of-cooking-part-1-the-food/

http://www.cooking2thrive.com/blog/the-benefits-of-cooking-part-2-the-fun-2/

http://www.cooking2thrive.com/blog/the-benefits-of-cooking-part-3-the-lessons/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

April 15, 2019

Preparation for Healing: When it Comes to Healing, Words Will Often Fail Us!

When it comes to healing, words will often fail us. I love words. They have, in fact, had a profoundly positive effect on me. But I also know from experience that when it comes to healing, words are a shortcut at best and at worst a shield or subterfuge.
no words
We like to think that words are the key to healing. They are useful. We use them to communicate our symptoms to physicians. We use them to describe how we feel to therapists. Once we’ve done this, we will be on the path to healing, right? Maybe, but not necessarily.

If you’ve ever had the experience of misdiagnosis or no diagnosis for years in spite of multiple attempts to describe your problem to the doctor, you know that your words are not always sufficient to communicate what is happening in your body. If you have lingering wounds from traumatic experiences, you may have no words regarding those wounds. You may have only intense feelings that flood back unexpectedly.

It shouldn’t come as a surprise that words can fail us. Think back to some moment of extreme excitement. Were you more likely to say, “I’m excited!”, or to jump up & down and squeal with delight? Think back to a moment of extreme fear. Did you say, “I’m afraid!”, or did you scream, shiver, or freeze? What happened when you felt extreme grief or tenderness? Could you speak around your tears? Deep emotions often find their expression throughout our tissues and our most profound moments often leave us speechless.

But the inability to voice our most deep seated wounds may be a result of the changes trauma makes in our brains. In “The Body Keeps the Score”, Dr. Bessel Van der Kolk describes brain scans that show the Broca’s area goes offline when a flashback is triggered (1). That is the area of the brain that allows us to put our thoughts and feelings into words. No wonder we refer to horrific events as unspeakable.

This means that the deeper and more meaningful the healing work, the less likely it is that language will be a sufficient carrier of information. Art and music can help some of us express those things we can’t describe. But perhaps it’s more important to know that we can heal without relying on language.

Sometimes it is the feeling encased in a memory that is more significant than a remembered event or image. Allowing the body to process these feelings without slowing down to describe the process is not always a bad thing. Not only can it reduce anxiety, it can reduce chronic pain, lower blood pressure, and possibly reduce inflammation as well as promoting better sleep quality and reducing the risk for depression.

In an era during which we are reexamining the treatment of chronic pain, it is important to note that according to the Institute for Chronic Pain: “As a group, people with chronic pain tend to report much higher rates of having experienced trauma in their past, when compared to people without chronic pain. It is a common and consistent finding in the research.” They go on to state that at least 90% of women with fibromyalgia syndrome and 60% of those with arthritis report trauma in childhood or adulthood; 76% of patients with chronic low back pain report at least one trauma in their past; and 58% of those with migraines report a history of childhood physical or sexual abuse, or neglect.(2)

As our exposure to violence increases through the myriad outlets for viewing violence, it becomes even more critical that we understand the limitation of using intellect and words to heal from any resulting trauma. Traditional counseling may not be helpful to survivors of a mass shooting, and some psychiatrists have come to view medication as nothing more than a band-aid.

On the other hand, in many circles, talk therapy is still viewed as the most important path to healing from emotional distress. Even in more progressive trauma treatment like Eye Movement Desensitization and Reprocessing (EDMR) and Progressive Counting, participants are asked to describe a memory before the eye movement or counting process begins.

Last year, I was exploring the possibility of traveling for an intensive therapy retreat with the Trauma Institute & Child Trauma Institute. The founder of that institute, Ricky Greenwald, PsyD developed the technique of Progressive Counting. The process of Progressive Counting begins with your earliest traumatic memory. You describe that, then the practitioner begins counting. Once you have resolved that trauma, you move on to the next one you remember. The idea is that clearing the old traumas first will make the more recent ones quicker to heal because the early baggage is gone. The Institute’s website states most clients are able to achieve true healing in a couple of days to a couple of weeks. That sounded appealing.

Then came the reality. Count me on the two week end of the spectrum or more like 3 weeks. After my assessment, I was looking at an estimated 21 days and $20,000+ of treatment. But the depth of my disorder is not the point. The point is that they administered a phone assessment during which I was asked to relate something typical my mother had done that felt traumatic to me.

I could not speak. In fact, I could not think. I was silent on the phone. I moved into a feeling of distress. I couldn’t even find my voice to tell them I could not answer. When I could speak, I was aware I sounded like a crazed person pushing past tears. I also knew I was doing the best I could and they had asked me to do something that wasn’t possible.

The assessor (actually there were two of them on the phone) quickly and deftly moved me away from the past and back to the present. But because they had made a request beyond my ability to perform and I had entered fight/flight/freeze/fawn mode and because this vulnerable state was only acknowledged by quickly moving me away from the moment rather than providing support through it, I felt diminished, dismissed, and distanced — the same feelings that come from neglect.

I have experienced a similar response to freezing from other therapists. I’m not sure whether it’s because the inability to talk is viewed as a voluntary refusal to participate or talk is just valued as the only path to improvement. Whatever the reason, the failure of professionals to provide support in the moment affects my ability/willingness to trust them and the process. Do they not understand what is happening (are they competent and well trained) or do they not care (are they truly compassionate)? Either way, my distrust in this instance was too much to overcome. These women had failed to earn the right to know my most vulnerable parts. Needless to say, I opted out.

That does not mean that Progressive Counting would not be effective for someone else or even for me with a different practitioner. And that experience was the opposite of the experience I had with a Somatic Experiencing Therapy practitioner in which I felt totally supported. In other words, that experience does not mean I was left with no path to heal.

What all of this comes down to is I want you to know that I know how it feels for words to fail you. I understand that if that happens in the presence of a professional who does not respond in an understanding or supportive way, you may view the process as harmful. If so, you can leave that particular opportunity behind. There are other paths.

If you believe that such an experience confirms that you deserve to be harmed, be invisible, or be unsupported (or whatever you tell yourself when bad things happen), that is not my view. You deserve to be treated with respect, have your concerns heard, and never to be dismissed or made to feel less than. If that is not the care with which you are being treated, I am so sorry and it is okay to say no to a particular provider and/or method. You know best what feels appropriate for you.

It is worth repeating that like mindfulness practices, healing is a process you can tailor to your specific personality and experience. If you are at a loss for words, or when they fail you, Somatic Experiencing or Tension and Trauma Releasing Exercises (TRE®) Therapy (also known as trembling) may be appropriate. Yoga or neurogenic yoga may also be helpful in supporting all other therapies.

Even if you struggle to communicate your distress, the body provides a path to healing when words fail. I am grateful for that!

(1) Van der Kolk, B., MD. (2015). Looking into the Brain: The Neuroscience Revolution. In The Body Keeps The Score (pp. 39-44). New York, NY: Penguin Books.

(2)http://www.instituteforchronicpain.org/understanding-chronic-pain/complications/trauma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848846/

https://www.webmd.com/mental-health/mental-health-psychotherapy#1

http://therapyretreat.org/

https://traumaprevention.com/

http://www.cooking2thrive.com/blog/3351-2/

http://www.cooking2thrive.com/blog/preparation-for-healing-managing-expectations-begins-with-setting-clear-intentions/

http://www.cooking2thrive.com/blog/preparation-for-healing-what-is-readiness/

http://www.cooking2thrive.com/blog/never-surrender/


Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

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April 8, 2019

Patient and Family Centered Care You can make a difference

When it comes to Patient and Family Centered Care (PFCC), you can make a difference. My family has spent a lot of time in the hospital this past year-more than 160 days since April 2018. That’s a lot of time to observe a lot of things.
hands
Every hospital is different. Like families, each has its own culture. Departments and even units within a hospital have their own subcultures. In some institutions, the lack of an overall policy results in units developing their own policies.

Communication between units is often lacking so a patient may be transferred from one unit to another within an institution only to experience a confusingly different policy on patient communication tools, changing bed linens, who attends rounds, visitor access, response time to patient calls, etc.

As a patient, you are most likely sick, injured, or weakened in some way. On top of that, you are vulnerable to the expertise, decision making, and implementation of treatment plans at the hand of many, many strangers who you have no chance to vet. That is distressing enough. Adding confusion, inconsistency, and unresponsiveness creates an environment that’s, let’s just say, less than healing.

If you have been a patient and/or family member who has experienced less than acceptable care, you may want to explore your hospital’s policies and participation in Patient and Family Centered Care. There could be an opportunity to provide input that will improve the hospital’s process to benefit patients.

Although Patient and Family Centered Care as a concept has been around for more than 20 years, it has not always been treated as important to healthcare. With participation in Hospital Consumer Assessment of Healthcare Providers and Systems Surveys (also known as Hospital CAHPS®) through Medicare and Medicaid and the public reporting of resulting data, hospitals are increasingly focussed on learning about and improving the patient experience. This has brought additional attention to PFCC.

Patient and Family Centered Care seeks to collaborate with patients and families as partners in care. The four basic tenants of PFCC are:
1. Dignity and Respect
2. Information Sharing
3. Participation
4. Collaboration

Simple enough, right? Of course not when you’re attempting to implement these into a system that has avoided information sharing and often treated patients as subjects rather than people. The good news is that you do not need medical training to relate the patient experience so your voice can be powerful in implementing change.

I sit on a PFCC Hospital Advisory Council. Over the past year, we have helped mold new ICU security policies, changed the language used in scheduling phone scripts and advance directives, given input on opioid risk assessment tools and MyChart content, reviewed food service menus, revised design and use of patient communication boards, and helped implement a hospital-wide linen policy.

In May, council members will begin sitting in each hospital unit to observe and speak to the nurses to determine the obstacles that prevent prompt response to patient calls. The information we gather will be transmitted to our Director of PFCC who will then meet with hospital leadership to determine how best to improve response times.

Our council is a mix of volunteers, hospital staff, and an MD who serves as the Associate Chief Quality Officer for Patient Experience. Some volunteers are retired nurses and medical school professors. Others are business people and community members who are patients or patient family members. Volunteers are required to attend orientation, be familiar with hospital codes, and get a yearly TB test and flu shot (or wear a mask during flu season).

For projects like call response observation, we also receive training for the task. It is our role to be a friendly ear to gather information, not to criticize or make suggestions while in the units. If we have specific concerns, those will be communicated to the Director of PFCC for inclusion in her presentation to leadership. The process is working well enough that current hospital leadership has given PFCC a great deal of authority and priority.

If you feel the patient experience could be improved at your local hospital, you may want to volunteer to assist with, or help the hospital explore implementing, Patient and Family Centered Care. Dedicating your time now can result in a better patient experience for you and/or your family in the future.

Given the amount of time my family is having to spend at the hospital, that seems like a worthwhile investment.

http://www.ipfcc.org/

https://www.medicare.gov/hospitalcompare/data/overview.html

https://www.cms.gov/Medicare/Quality-Initiatives-patient-assessment-instruments/hospitalqualityinits/hospitalhcahps.html

https://medium.com/@cooking2thrive/id-tell-you-but-then-i-d-have-to-b49d9b2d3900

http://www.cooking2thrive.com/blog/heres-an-idea-for-an-app/