My psychiatry professor asked our Death and Dying class “at what age do you expect to die?” This question was met with a variety of responses:  Furtive glances at others, hyperventilation, sweating, a quick search for the exit door, anger and disbelief.  We thought he was kidding.

“No, really”, he said, “I think I’ll die in my late 70s.  What about the rest of you?”

This was a tough question to spring on us and I wondered what it had to do with patient care.

As scientists, some of us began discussing the predictive value of genetics with the addition of future medical advances minus high risk sports and unhealthy habits.  One of my classmates began to feverishly construct mathematical formulas.  Others stared blankly out the window.

I raised my hand.

“Why do you ask?”

“So you’ll have greater empathy for your dying patients.”

He seemed to think it was time to shake our denial; to teach us some humility; to open our minds.

I thought he was unreasonably provocative.

I said, “I don’t want to think about when I will die.  Maybe it will jinx me.  Maybe I’ll have a subconscious deadline.”

I wondered if he were casting a spell.  Maybe I was just being rebellious.

“All right then.  At least 100 years old!  Are you satisfied?”

“Do you mean it?”

“What?  That I expect to make it to 100 or more?  Well yes.  God willing of course.”

He thought I was resisting his question.

If I could avoid the issue of mortality I would not have to fear it.  I would not have to consider loss of function or the loss of possibilities.

Naturally I knew none of us would live forever but I didn’t want to feel it.

The denial of death and the illusion of immortality helps people go into combat, engage in high risk behaviors, and delay important decisions like where to go with a career, whether to have a family, and how to plan for retirement.

The awareness my professor was inducing had drawbacks.  Some of my classmates stopped taking public transportation late at night.  My lab partner cancelled his sky-diving lessons.  I stopped riding my bicycle to class through a rough part of town.  Our rugby team lost some members.

I asked my professor “Why do you think we should increase our awareness of our own death?”

“Because it will increase your awareness of the death and dying of your patients and make you better doctors.”

“Is there something you want us to learn about ourselves?”

“I just want you to have compassion for your patients.”

I decided there had to be more that he wasn’t saying. I thought I had plenty of compassion but it was clear that I did not want to confront my mortality, at least not in front of him and my classmates.

Years later my professor’s question began to make sense to me.  My best friend Jake died in a freak midair collision just after medical school.  He left behind two young children and a loving wife.  My next best friend Kevin endured a losing battle with brain cancer.  A brilliant psychologist, he was well aware of life and death.  We talked and cried together.  One evening as the sun was setting outside his hospital window, he raised his arm weakly so the rays of sunlight would rest on his skin.  “Pretty” was all he said. I finally understood another lesson my professor was teaching:  Life is delicate and temporary and it’s meant to be savored, even during the hardest times.

Acknowledging mortality, although it can be sad and scary, is liberating.  Awareness of death can help us savor the big events and notice the little moments of life; to honor the people who we care about and who care about us; to do the things that are important, meaningful and enjoyable rather than delay them; and to feel grateful for what we have.

My psychiatry professor became my mentor.  Through him, I met numerous famous people and became aware of a world I never imagined in my small rural childhood town.

One of my professor’s houseguests, Elizabeth Kubler-Ross, wrote the book On Death and Dying.  She was a delightful free thinker who later in life lived communally and took an interest in mysticism.  I hoped she found the answer to what happens after death before she went there.

Being aware of mortality is less painful for me now.  I don’t fight the notion of dying as much as I used to and I am more grateful for being alive.

Death teaches us about life – not only how precious life is but also how important it is to live it meaningfully and responsibly.  Awareness of death highlights the value of life.

I learned about my professor’s death on a National Public Radio show honoring his life.  John Fryer did not make it to his late 70s.  Sadly, perhaps because of his genetics and how intensely he lived, he died at age 64.  During his life he lived fully with few regrets and much gratitude.  Maybe that was part of his lesson.

The post Are You Still Immortal? appeared first on Bick Wanck MD & Associates.

The gene pool has a lifeguard called epigenetics.

Using healing enhancers will help it come to your rescue.

You can influence which of your genes are switched on and which are switched off with what you eat, how much you exercise, and how much stress you allow in your life. The science of epigenetics explains how that works.

As a human, you have approximately 21,000 genes. But you also have 50 to 100 “marks” for each of your genes. Your marks are switches that turn on and off your genes. These marks or switches are what you can control by what you eat, how much you exercise, and how much stress you experience.

Conrad Hall Waddington (1905–1975) proposed the term epigenotype in his 1939 book, An Introduction to Modern Genetics and in 1942, in an article called “The Epigenotype.” He described epigenetics as the means by which your genetic expression is affected by how you interact with your environment.

The most noticeable effect of epigenetics is seen in how tissues differentiate. Your brain cells and your bone cells share the same genes, yet they look and behave very differently from one another. The difference is because of which genes are switched on and which ones are switched off. The switches are determined by epigenetics—in this case, by the effects of chemicals from surrounding cells.

Just as epigenetics determines where you have brain cells and where you have bone cells, it also determines whether to switch on genes of wellness and whether to suppress genes of illness. It’s been shown that childhood abuse results in changes in epigenetic effects on gene expression. Researchers at McGill University showed that genes were switched on and off differently in people who suffered childhood abuse than in those who did not. They theorized that this could explain higher rates of illness in those who suffered childhood trauma.

Epigenetics Can Protect Future Generations

We already know about epigenetic defense mechanisms. Disease-causing genes can be silenced when epigenetic effects prevent their expression. This explains why one identical twin can develop bipolar disorder (manic depression) while the other does not. They were affected by different experiences and by different sets of behaviors. Those differences affected gene expression epigenetically.

What you  experience and how you behave can even affect future generations in two ways:

1. If you model healthy behaviors and resilient attitudes for your children or for other children, they may adopt those behaviors themselves. Those healthy attitudes and actions can change their genetic expression. They may be less likely to express an inherited case of anxiety, depression, or physical illness. Their epigenetics might overrule their undesired genes by not allowing them to switch on.
2. Sometimes epigenetic influences may be transmitted to subsequent generations. In a landmark study published in 2014, researcher Lars Olov Bygren and his team[CJ1] [BW2]  found that the children and grandchildren of people who suffered through a famine lived longer than expected. They lived longer because they did not develop obesity. It was the first time an epigenetic trait was shown to be inherited by subsequent generations.

Hopefully one day we will be able to show what effects specific types of diets, exercises, meditations, and social interactions may have on genetic expression. If we know what genes need to be suppressed and what behaviors will do that, we may be able to tailor a particular type of exercise or diet or meditation to prevent a particular type of illness in someone who might be inclined to inherit it.

Enhancing one’s healing with positive attitudes, healthy behaviors, and compassionate love has been shown in studies to be so strong that it can rival the effectiveness of some medications. When well timed, healing enhancements can, in some cases, prevent the need for medication. When medication is needed, they can strengthen its effect.

Be sure to discuss your plan for exercise, diet, and other healing enhancements with your health care providers. It is especially important to discuss medication decisions with your prescriber. Healing enhancements can help you get well and stay well, but they should not be undertaken until you have discussed them with a qualified professional.

I hope science will convince you that adopting a set of healthy attitudes and behaviors will be worth the effort. If you go to the trouble of practicing healing enhancement in your daily life, you’re likely to see payoffs. You’re likely to feel better and have more energy, and you may have less need for medication.

The genetic lottery is not so risky when you work with your epigenetics. By influencing which genes are switched on and which genes are switched off, you may be able to prevent (or at least mitigate) some illnesses and enhance your wellness.

The post How to Change Your Genes appeared first on Bick Wanck MD & Associates.

Mindfulness

I recommend a daily three-minute gratitude ritual.  This starts with quieting your mind by paying attention to your breathing to help you become aware of the moment.  Here’s my favorite ritual.

With each slow breath, I say:

Thank you God for this moment,

Thank you God for this place,

Thank you God for the water,

Thank you God for the air,

Thank you God for the light,

Thank you God for this life.

Thank you God, Thank you God, Thank you God.

In place of God you can thank the Great Spirit, the Great Mother, Allah or whatever force you believe has given you these gifts.

Exercise

I recommend at least three minutes of daily exertion.  Exertion means you are breathing so hard you can’t have a conversation.  This may involve running up and down stairs, doing push-ups, crunches, and squats (modified as needed), or running in place.  You don’t need to change your clothes (sweat from exercise doesn’t stink like sweat from anxiety), and you can do your exercise of choice before lunch, between meetings, or when you first get home.  No one will miss you for three minutes (okay, maybe a crying baby or puppy).  And whatever exercise you enjoy or do routinely, but ALWAYS do at least three minutes of exertional exercise daily.  You’ll be amazed and pleased by the results – within weeks you’re likely to feel stronger, more toned, and more energetic.  Exercise is one of the best MEDs you can take!

Diet

I recommend you avoid sugar to reduce mood fluctuation.  By curtailing your intake of sugar, you’ll have more consistent energy, and you’ll lower your risk for diabetes, hypertension, and heart disease.  You’ll feel better and live longer!  No matter what diet you follow, whether it’s gluten-free, Mediterranean, vegetarian, vegan, or Paleo, you’ll feel better and you’ll be healthier if you eliminate sugary sweets.

Stress Management

I recommend saying NO!  Say no to unnecessary activities.  Say no to unnecessary work and relationship drama.  Say no to requests for your time when it’s not crucial.  Say no to unhealthy urges.  But say YES to getting enough sleep, spending less than you earn, and surrounding yourself with kind and loving people and animals as much as you can.

By consistently practicing these daily M.E.D.S., you’ll reduce your stress, feel good about yourself, and live longer!

Before you begin your “M.E.D.S.” be sure to discuss them with your healthcare provider.  It’s necessary to be sure that the activities you chose, particularly diet and exercise, do not cause you any harm.

The post The Best M.E.D.S. for Stress Management appeared first on Bick Wanck MD & Associates.

One of the most meaningful aspects of your life may be providing service to others. This could involve raising a child, caring for a parent or a pet, helping a friend or sibling, or performing service for your community or for an organization. Helping others may be a calling or an enjoyable sideline activity. Helping others can help you to feel connected and worthwhile.

Sometimes helping others goes too far. You might have an overdeveloped sense of responsibility or you might feel obligated and trapped. It’s easy to get out of balance when you help others. If you give too much, you can deplete yourself. If you don’t get enough back, you can feel resentful. If you feel you must shoulder someone else’s load, you can overwhelm yourself. If you do so much for others that you have little time for yourself, you can feel like you are suffocating.

Here are three things to keep in mind as you provide service to others. Practicing them will help keep you from feeling depleted:

          1.  Maintain a quid pro quo
          2.  Stream rather than contain the suffering of others
          3.  Take time to recharge

     Maintain a quid pro quo

Quid pro quo means “something for something.” It means that if you do something for someone, you receive something in return. When you do something for someone as a family member or friend, the usual expectation is that you are doing it altruistically and that you expect nothing in return. This is okay for a while, but eventually it will feel unfair and you will grow resentful.

Perhaps what you receive in return is a feeling of satisfaction, or that by “paying it forward” you are doing the right thing. Maybe you believe your payback will come later from some other person’s good deed, or that your service will pave your way to heaven.

Most generous acts are performed with no expectation of a return. The giver feels good about giving, especially if the receiver appears to benefit or voices gratitude. That’s adequate payment if you have a generous heart and if you feel you have more than you need.

If you give consistently more than you receive and if you have no source of spiritual nourishment for it, eventually your emotional health could suffer. That is why it is important to try to maintain a balance. If you consistently give more than someone else and you feel drained by it, you may need to give less or ask for more in return. Over the long run, a balanced quid pro quo will help you maintain balance in your relationships and balance in your mind.

     Stream the suffering of others rather than trying to contain it.

Suffering usually comes down to a question of ownership. Can you really own someone else’s suffering? The simple and obvious answer is no … but letting go of the urge to help can be difficult. Witnessing someone’s suffering with compassion and constructive concern is not easy. It requires clarity and usually quite a bit of practice.

If your words and/or your actions are the cause of someone’s pain, it is right to take responsibility. If apologizing  does not add to the hurt, doing so will probably help. Taking action to repair damage you may have done is also a good idea if it does not compound the problem or place you in an overly compromised position.

If you are not responsible for someone else’s suffering, it is not yours to mend.  Becoming a witness to someone else’s suffering and offering observations and suggestions, however, can be extraordinarily helpful and healing for both parties. Having compassion for the suffering of someone you love or care about is right and good. Going about it in a way that does not harm you is necessary.

It might help for you to visualize yourself as a rock in a stream. As someone’s suffering comes into your awareness, witness it with compassion and loving-kindness. Remarking on it and reflecting observations about it as it flows around you can give great comfort to the sufferer without taking too much from you. Give as much as you feel is right for you, and sustain your own presence as their distress flows around you. Know that they own their discomfort or suffering, and wish for them a deepening of awareness and a resolution.

It’s possible for you to remain comfortable and within your own place as you offer kindness and support to someone you love. If you do this by streaming and not by containing, you will have room in your heart to continue to be present for them. In this way, you can be present for someone without losing yourself.

     Take time to recharge

Whether you do so alone or with others, taking time to recharge your batteries is vitally important. Consider this a quid pro quo for yourself. When you have expended a great deal of energy in helping others, it is only reasonable that you take some time to resupply your energy reserves. The emotional labor required in many interactions can be extraordinarily depleting. You will need some time to reconstitute yourself with enjoyable time on your own or with people who expect little or nothing of you.

When you take the time to take care of yourself with these three simple steps, you’ll be able to show up for those in need without draining yourself and without resenting others for it. You’ll be able to find meaning and fulfillment as you provide service for others.

HOW TO HELP OTHERS

WITHOUT DEPLETING YOURSELF

MAINTAIN A QUID PRO QUO

Keep a balance of giving and getting in your relationships.

It is important to get back as much as you give out.

STREAM RATHER THAN CONTAIN

THE SUFFERING OF OTHERS

Witness with compassion and loving kindness the suffering of others

without trying to take it for them.

Take responsibility for any pain you may cause but do not try to own

someone else’s misery.

TAKE TIME TO RECHARGE

Whether it be alone or with others, find ways to recharge your

batteries when you feel depleted.

The post How to Help Others Without Depleting Yourself appeared first on Bick Wanck MD & Associates.

The 3 A’s of successful coping are:

1. Accept
2. Act
3. Adapt

Anything you would rather not know about or comes as a shock can overwhelm your system with dread.  It’s natural to protect yourself with denial.  News that’s too big or too unwanted requires an adjustment.  You may not be ready to handle it.  You may prefer to run from it or to ignore it but the 3 A’s of successful coping will give you a way to manage it.

ACCEPT

            The first A is Acceptance.  It requires you to shake off your denial and grasp the reality of a situation you may not have wanted.  Once you accept the fact that there’s no escaping your situation, you are ready for the next step.

 ACT

Once you’ve fully acknowledged the fact that there is a situation you must deal with, it’s time to act.  Action involves two components:  gathering information and making a decision if one is needed.  There’s no turning back.  There’s no reversing course.  It is now time to incorporate your action into your life.  Take action despite fear but don’t let fear dictate the action.

ADAPT

Once you have taken action to gather information or to make a change of direction, it sets awarenesses and events into action.  These awarenesses and events then become inescapable.  When you take action, an entire sequence of events may unfold.  Now it’s time for you to adapt to the realizations you’ve made and the actions you’ve taken.  Adapting to the action you’ve taken may seem overwhelming or scary but you can do it by taking one step at a time.

Imagine that you’re running late for an important meeting and that you’ve just come upon a traffic jam.  Now is a good time to put triple A coping into effect.  Acceptance is easy; you may not want to believe it but it’s true:  You will be late for your meeting.  Next comes action.  Perhaps you’ll try calling someone but the most important action in this case is likely to be no action.  As long as you are safe, you could manage better by slowing your breathing and calming yourself.  That’s part of Adaptation:  You’ll need to adapt to your situation by breathing through it, adjusting your schedule and contending with whatever you’ve missed.

Here’s a tougher one.  Your latest medical tests indicate you might have cancer but you’ll need more tests to know for sure.  Acceptance here is tricky:  You have to accept that something scary might happen but you don’t know if it will.  Acceptance means not jumping to premature conclusions but also not ignoring a possible danger.  Action, something you probably would rather not have to do, means collecting information and making a decision to either delay the tests or move ahead with them.  Adaptation then means finding ways to avoid to either decision involves adjusting to how your decision changes how you see your world and what you need to do to manage it, such as who to tell and how to manage your schedule.

You can use the 3 A’s of successful coping for anything that happens in your life.  By practicing it with minor events, you’ll be ready if you need it for a major event.

THE THREE As

OF SUCCESSFUL COPING

ACCEPT

Shake off your denial and accept the fact that

there is a situation you need to address.

ACT

Take action by gathering more information and by

making a decision if one is needed.

ADAPT

Adjust yourself to what you know and deal with the

Consequences of your decisions.

No matter what has happened, you can manage it.

The post The 3 A’s of Successful Coping appeared first on Bick Wanck MD & Associates.

The Three Layered Healing Plan organizes a variety of helpful approaches in a way that best helps your mind to heal. The layers are organized by increasing need and intensity. You can add, subtract and modify the layers as you need to. Your objective is to give healing what it needs, so it can take care of you.

You might be tempted to jump to the highest layer of treatment (medication) without realizing that a less intense approach may be more effective and promote lasting change, producing the greatest long term rewards. The risk of rushing too quickly into using medication is that it could hinder the natural flow of your healing by blunting your emotions. It could also expose you to unnecessary side effects. Making decisions that are consistent with your natural flow of healing will produce greater long-term as well as short-term rewards.

The layers of assistance in the Three Layered Healing Plan are:

Layer 1: Enhancement

Using healthy attitudes, behaviors and compassionate love to empower your natural healing process.

Layer 2: Guidance

Gently but firmly redirecting the flow of healing with psychotherapy and
other non-medicinal treatments.

Layer 3: Restoration

Removing, with medical treatment (when needed), severe distracting or disabling symptoms in order to reengage the flow of healing.

With proper timing and skillful application, you can use these layers to synergize and complement one another while promoting your natural healing flow.

An effective healing plan incorporates as many of these three layers as are needed. It is not just a treatment plan, and it is not just a wellness plan, it is a comprehensive plan of wellness and, as needed, treatment that remains fully observant of and responsive to your unique healing style.

When things are going well and maintenance of a healthy resilient state is the goal, Enhancement may be sufficient. If you feel like you are going the wrong way with distorted perceptions and unskillful behaviors, Guidance, may be needed. If you have symptoms of panic, obsession or despair that are so severe that they distract or even block your capacity to take action to be well, Restoration with medication may reduce your symptoms enough to restore your flow of healing

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