Improving Mental Health With Mindfulness and Lifestyle Changes

While there is definitely a place for medications and drugs to treat many mental health disorders, there also needs to be an understanding that medications do not change the environment contributing to negative thoughts and behaviors. Psychotherapy, mindfulness training, and healthy living behaviors are also key to bringing a person back to mental wellness. 

One popular psychotherapy approach is cognitive behavioral therapy (CBT) - a type of therapy that has been studied in depth in both research and clinical settings and have shown to significantly improve a multitude of mental health disorders. 

CBT bases its treatment on the consideration that those who experience mental health disorders may have thinking behaviors that are unhealthy or unhelpful, that we have learned these patterns of unhelpful behaviors, and that there can be shown methods to better cope with these thoughts, behaviors and patterns to achieve symptom relief. 

CBT sessions are focused on changing a set way of thinking to try to re-position the mind to think differently about the same situation:

- Problem-solving skills to cope with challenging situations

- Understanding realities of situations, and realizing our distortions in thinking about these realities

- Learning and understanding motivations and behaviors of other people

- Developing confidence in oneself

- Learning and practicing mindfulness, calming and relaxation techniques

Additionally, paramount to improving mental health requires a holistic approach - often focus must eventually shift to incorporating a healthy lifestyle with good nutrition, regular physical activity, and routine and sufficient sleep, as well as stress reduction techniques (or changing a particular situation to remove stress if possible). 

There is evidence that nutritionally, fatty/greasy and high sugar content foods can worsen mental health such as depression, whereas foods such as eating more fruits and vegetables is associated with mental well-being. 

There is evidence that regular exercise can help build those endorphins that help you weather stress, mental and physical pain, sadness and despair. Even better is finding a physical activity you find interesting and working towards engaging in that interest - no matter how dark your journey is at the moment, no matter how exhausting, consider it a prescription from the physician to climb out of the deep darkness to somewhere where you can see the sun again - small steps at a time.

Developing a routine of good habits over time and staying consistent with these good habits builds overall confidence and self-esteem, builds a sense of purpose and achievement in life, which then helps shield against negative thinking and despair. It may help us re-wire our brain and balance the levels of neurotransmitters simply by thinking and living differently. 

The neurochemical biology of mental health disorders is very complex, however, and cannot always be improved by therapy or mindfulness alone - please do not vilify or shun the person who does not achieve the results you expected them to achieve with lifestyle changes. Sometimes, medications are needed to bridge over the darkness and this is appropriate in the course of treatment. We should reach for medication with caution, and as physicians, it is our duty to explain what we're prescribing, expected outcomes and potential side effects. Some of these medications have significantly changed the course of lives of many, so it is still beneficial to consider this option as an adjunct to therapy and lifestyle changes. 

Here are some affordable resources to consider to help guide you, especially if you feel you're going through a bout of mental health challenges. Asking your physician for specific recommendations for community CBT resources or therapists is highly recommended, as a dedicated therapist on your team can tailor treatment to you individually and make the most of a therapy session. 

Engage with your physician to work on lifestyle changes - even though this may be one of the most challenging things you do while you battle mental illness; it will help pave the way for long-term mental health healing and stability.

Be Mindful Online - CBT Online Course (Complete At Your Own Pace)

Meditation Short Audios - Guidance

Financial Disclosure: Dr. Kristine Tsai receives no monetary compensation for referral to these websites on this specific post.

Why Is My Cold Not Treated with An Antibiotic Right Away?

Physicians are often put in quite a challenging position when trying to do best by their patients. One of the most difficult pieces is offering an appropriate treatment plan for upper respiratory infections (or common colds and acute bronchitis) - often which just tender loving care, rest, hydration and nutrition will support your body to fight of the infection on its own. We try our best to hold off on antibiotic treatment because there is inherent harm to the patient and the community from over-prescribing. Here is one of the most common disappointments I see on patient surveys:

"I went to see my doctor, and I had this miserable cold! She said I was going to be fine and sent me home! What a waste of my time and money! That doctor was useless!"

Patients: I absolutely hear your frustrations on the above, and hope we can communicate better regarding care plans. In fact, when I was an undergrad in college, I had the same complaint about my own sick visit. I was prescribed some OTC allergy pill, and was so upset I wasted $90 to be told it was nothing when I felt so awful. Did I get better on my own? Yes. Didn't even take the allergy pill. Learned a lesson that year. 

To help everyone understand, here's the Physician reasoning:

Your current infection is probably caused by a virus.  Antibiotics cannot kill viruses. Viral infections can last about 2-3 weeks, but you will slowly begin to improve on a day-to-day basis, although it may feel like it’s slow and lingering.

Often times, most of your symptoms would have improved after 2-3 weeks, but you may even have a lingering cough that could last 4-8 weeks. This is part of the inflammation healing process, and it is not a type of bronchitis that can be healed by antibiotics.

Anti-viral medications for Influenza and COVID19 are available. These medications are very helpful to prevent severity of these specific viral infections (not other common cold viruses). You must test early for these diseases to make taking the medication effective and worth it --- another reason why we still recommend testing for COVID19 and the flu early in your symptoms as a helpful way of managing these diseases. 

These are the reasons antibiotics can be a problem if it is prescribed too often (or reasons that it should be prescribed with caution):

•  Antibiotics can cause side effects and allergic reactions – some people get nausea/vomiting, others diarrhea, and others end up at the hospital with swelling and rash.

•  Antibiotics can destroy your good gut or intestinal bacteria. These good bacteria help with overall appropriate digestion and movement of your bowels. Good gut bacteria can also prevent deadly overgrowth of bad bacteria. One of the most common dangerous overgrowth is by Clostridium difficile (or C. Diff). This is a very serious condition that can cause inflammation in your bowels and can be very painful or simply very smelly. It also causes a severe diarrhea that would not go away, and this infection would then need more antibiotics for treatment. Antibiotic use can also lead to increased risk for fungal or yeast infections.

•   Antibiotics overuse can lead to resistant bacteria – this may mean that one day, if you were in a situation which requires the use of antibiotics (for instance, in burn patients, transplant patients, cancer patients, and those with deadly infections), the antibiotic had stopped working on the bacteria because it was overused, then it is now a matter of life or death. There are already people in hospitals that struggle with this now. Unfortunately, we don’t have newer antibiotics to fight these infections at this time.

"Doctor, ok.... I understand you don't think it's necessary for antibiotics, but I'm miserable. Why aren't you doing anything for me?!"

Here is where I feel bringing this up with someone who is on your trusted health care team can make the difference (rather than going to a Big Box Store Clinic). You will feel much more comfortable telling a physician you've known for years how awful you feel and that you don't agree with that TLC-rest/hydrate plan (or your physician will notice how miserable you feel because they've seen you on your good days). Bring it up: Say - my cough is bad, can you please prescribe something for it?

This is again, part of the team approach to care. Please openly communicate how miserable you feel and what symptom(s) you need us to address the most right then and there. We might not be able to cure your viral infection right away, but we might be able to help ease the course. 

"So what if my symptoms are getting worse even after a diagnosis of viral infection?"

Physicians don't have a magical scanner in our eyes and cannot predict if your currently benign infection is going to progress to pneumonia or a bacterial infection. We make risk assessments based on progression of a disease. I always say, what is occurring one day can change quickly in the following days. 

We do not recommend antibiotics to “prevent” things getting worse or "getting ahead of the infection" for the above reasons written. However, there is always a chance of your symptoms getting worse and leading to such a complication, although this does not occur very commonly in every infection. Some people tend to have more complications than others. The most appropriate way to handle this situation is to keep your physician in-the-know (another good reason to seek out your primary care team to help, because they follow you all the way). Please understand that sometimes another office visit may be required to evaluate your symptom progression because certain diagnostic tests may need to be ordered or certain antibiotics only work for certain infections such as pneumonia, and we should see you to try to get the right diagnosis to give you the best prescription possible. It may seem inconvenient, but it is the best way for us to take care of you and get you feeling better sooner and stay out of the hospital with the least amount of side effects and harm as possible. 

If it feels very miserable, then find us early so that we can test you for flu and COVID19 and check for pneumonia or other diseases as soon as possible. However, if it feels like a mild common cold and you test negative for COVID19 at home, then you might not need to come see us at the very early part of your cold each time.  Check-in with your physician to see if they want to see you right away.  You may save yourself a co-pay.

Surely if your symptoms are still not improving, and it's been more than 10-14 days or you notice worsening or scary symptoms, come find us - we're here to help rule out the bad diseases, provide treatment/therapies when indicated, and sometimes advise reassurance as well. It also puts you on our radar in case you call back saying... something's not quite right. 

An Odyssey of Life

Poem by Dr. Kristine Tsai

COVID19: Are We Finally Reaching Endemic Phase? Can We Finally Hope...

What an unpredictable, insane, stressful, anxiety-ridden 2 years this has been. Today marks the day that I recall my family and I were readying ourselves for our last real vacation, even on the heels of a slight worry that something was beginning to emerge from the frontiers of distant lands. I still recall the feeling: the virus is concerning, but - I believe that modern science is solid, capable and intelligent - surely with our ability to sequence a virus so quickly, and with vaccine and pharmaceutical technologies we have, we can get ahead of it soon.

Well --- This has been a rollercoaster ride for sure. It's not the end of the ride, but I surely hope those twists and turns are beginning to become little hills and waves as we're reaching the end of the ride. Despite having the tools of modern science to create vaccines that can more effectively than not keep people out of hospitals, ICUs and ventilators, who would've known that politics and social media has made these last 2 years one of the most polarized and opinionated Twilight Zone-type movies I've ever imagined and felt like I was actually playing a part.

I wish our world would've been as easy as in Contagion - the movie that came out in 2011 (many years before COVID) where the symptoms appear far worse, but the world seemed to have got together, figured out a vaccine, and distributed it widely to cure a disease that was destroying the lives of many. No crazy social media issues. Some politics, but nothing too contentious. If it was like that, we may have been done already.

When people tell me COVID is not that bad, that the vaccines aren't needed -  it makes me really sad to think --- they must not know the healthy middle-aged gentleman who got a stroke while infected with COVID (unvaccinated), the young lady who developed new blood clots in the lungs (unvaccinated) while infected with COVID without other cause, the young college student who died on the vent from COVID respiratory failure and the many, many grandparents, mothers, fathers, sisters, and brothers who have died. We in healthcare walked with them. We have also met and held the hands of many survivors, as they worked through 3-6 months of recovery from COVID (even if they weren't in the hospital). We saw a different reality - and it was hard to share, because we weren't believed. We were just a part of the media or propaganda. 

Then Omicron came about - and it made it so hard for us to convince people that it was all worth it. Getting the vaccines, quarantining, masking, testing - all the crazy things we had to do, all the time and money we had to spend, all the worrying, worrying, worrying. Omicron made my patients who originally supported vaccination doubt the utility of it (even as it kept them out of hospitals). I try to explain to people: we got flu shots every year, and invariably, I may get the flu, but only for 2-3 days, unlike my flu-unvaccinated who have it longer and more miserably. I am so grateful to get vaccinated every year. Some don't realize - this COVID19 vaccine may have actually saved their lives. We may only think: it was miserable, I was quarantined, I couldn't do anything, people looked at me and thought I was the plague, I have guilt, and I can't believe this happened to me. Isn't that what vaccines are for? It was supposed to make sure I did not get this virus.  Forget the Booster. 

I will remind everyone again, and again. Vaccines are not 100%. They never are and never will be. But they can be very effective doing 2 things - either preventing infection (not as effective in the case of Omicron) and/or preventing complications/hospitalizations (this is still very true).  The effectiveness is compounded and made more real - when the vast majority is also vaccinated and boosted or has strong immune presence against the virus. 

The Boosters are needed to complete the COVID19 vaccination series (truly it should be a 3-shot series, like some Hepatitis B vaccines), but many are disillusioned from this last viral wave. 

I will tell you one thing as a practicing physician in the trenches. Those of us in healthcare are very tired. We want to do the right thing, and recommend the best preventative care to everyone. But the pushback and the distrust has left us somewhat hardened and cynical as well. Your choice? Sure. I respect that. If you ever want more information, please feel free to ask - but my days of passionately discussing and doing a short science lecture for every patient? I'm not sure I have the energy to do this anymore. I will simply advise it's the smartest thing to do - benefits outweigh risks - but if the reply is a "no" - I might not explore why as in depth as I used to. I hope this feeling goes away soon. I know how precious and important our discussions are - but until you trust me to give you the right information, and you ask me specifically with curiosity and intent, I might carry a bias about you - that you do not care about COVID19 and the vaccines, and you don't care to know more. This bias is not a good thing - I totally admit to this, but physicians are humans, too - and we need your help to rebuild our patient-physician trust. You must trust that I have your best interest at heart, that your physician's medical opinion might have more good reasoning behind a certain treatment or procedure option than Joe Schmoe or Janey Doe from YouTube or TikTok or some Spotify podcast.  

Believe me. We're COVID exhausted, too. All of us need to work on recovering our humanity as well as find our new routine and lives -while living with COVID.  This is our new reality. Endemic means - we'll live with COVID19 - there will be ups and downs, we may get summer colds (more than we used to). We will need to still protect ourselves with the best tools we have, especially during the "season" when we see more infections - and use those tools to help those who are not as fortunate, are immunocompromised and need us all to be their heroes and protect our community.

My truest and dearest hope is that as we begin to settle our negative emotions about this pandemic, as the shockwaves begin to lessen, as our personal anxieties, guilt, blame, and cynicism begin to wane - we can look outside of ourselves, outside of our bubbles, outside of our own defense zones and begin to reach out a hand to help one another again. I hope that we can begin to stop feeling like the whole world is out to get us. Rather, I hope that we realize: We have purpose for this world -- that each one of us can bring a light to the world that no others can. We can stop feeling offended about every small thing, but begin to positively inspire people to do better. To create positive change in this world still requires a lot of grace for everyone - to allow people to make mistakes, but have the heart of gold to teach them that it is very human to make mistakes, and to consider another way of thinking or living life for the benefit of our self and others. These are hard discussions but they can be respectful and wonderfully done.  Can we all strive to be real and amazing leaders of the new world we wish to forge instead of forging it with fire, hatred, one-sided opinions and oppression? 

All of our hearts need to heal. I hope we can truly begin this year --although so much unpredictability... but, hey, one can hope and dream, yes?

2022 - perhaps now we can really say, Happy New Year - it has only just begun.

 Daily Mindfulness Mantra: 

"To feel the Sun, be the Sun"

As we begin this New Year of 2022 with some gloom and doom, and Hope's flame seeming to dwindle to the point of non-existence, I beg of you all, do not lose sight that humanity has time and time again, brought back to life the flames of greatness from depths of despair.  We shall work on our patience this new year, of honing ourselves to Be the Sun for ourselves and others, and below is a roadmap of how I feel we can each individually make this happen. 

Positive thinking and perspective is often a very large facet of how we can find joy, happiness or contentment in our lives. Especially now, we must focus on this. I have asked patients during these dark days of the pandemic to pay attention close-by, to your close surroundings, to your own self and well-being. And when you've healed you and your inner circle, you will feel better able to reach out to begin to heal our world. It really does start with you.

Every day - practice these mindfulness exercises, perhaps at the beginning of your day while you're either still in bed and staring at the ceiling or brushing your teeth looking at a wayward strand of hair or your tired unforgiving eyes, think to yourself these following things:

Who or what am I Grateful for today?

We shall begin the day by being thankful - thankful that we may have some privileges and comforts that others do not have. We have security in certain areas of our lives that others do not. Despite what you may believe, many of us often have in our possession something, someone, some skill, some character, some talent, etc. that someone else might not. You will begin your day by acknowledging this. 

What is one thing that I will Forgive today?

Forgiveness is a powerful tool. Rather than holding on the negative energy of grudges, envy, regret, despair, guilt, spite, dislikes or hatred, we begin our day with forgiveness. To forgive does not mean to forget - it means that we remember the issue that may require our forgiveness,  we acknowledge our discomfort with what had happened, we then forgive this (meaning, we let the negative energy surrounding that memory go), we consider what we've learned from the experience, and then we open a door in our mind to move on to a beautiful new and empty life canvas for which we will paint our next experience. The burdens of the negative energy, lifted off your shoulders, is quite the freeing experience. 

What is my Purpose for today?

Although the term "purpose" may sound like "duty" to some, I want to allow you the freedom to define it to anything you think this can be. Your purpose could be simply to get up and present yourself to the world. It could be something you've been thinking about doing, but today is the day you will make this your purpose. You will begin a process, or you will complete a process. Your purpose is always open to definition by you. Remember, your purpose is what propels you to live your life, and for some, we must consider this day-by-day. Although this ties into some people's idea of long-term goals, plans or achievements, I suggest you package it small, and make just one do-able purpose for each day. Fulfilling your daily purpose that you set for yourself will allow you to build self-awareness, self-confidence, and a sturdy sense of self-achievement over time. 

What is one thing in my life that brings me Joy?

Despite what some may believe - that perhaps there is no joy in their life - I would like everyone to reconsider that perhaps, there is one small daily thing that actually does bring you joy. You must focus on this one small thing until you can rekindle your joy through meaningful life moments and purpose. I suggest that you do not depend on other people for your joy especially if you tend to seek validation from others, but start from things such as... the small flower on the windowsill, a book you've recently read, a quote or meme that resonated with you, the taste of a sweet fruit, a fluttering majestic flag in your neighbor's yard, a butterfly that flew past you on your way out the door. Of course, if a major accomplishment brought you joy, bask in that sunshine - you totally deserve it!

Find Joy within yourself and your moments of life... by being mindful of your surroundings, your senses, and all your lived experiences. 

What is one thing I can Help others with today?

Many forget that most of us are integrated into society one way or another. Human beings are social beings and even if you are strongly averse to society, at some point you interact with society. Your help doesn't need to be grandiose or change the world. It could be as simple as holding a door for others, or making sure to share a kind word. It could be watching out for your co-workers or friends and asking on their well-being. Anything thoughtful is an exercise in compassion to others which is a vital part of how society can be vibrant and whole. Your small act of kindness, which is a kind of light that only you can make: think about what this could be, each and every day. 

***

If we can ask ourselves to run through these thoughts every day at the beginning of each day - even if our responses haven't changed in a while - it can help us reset our outlook to begin to take on each day with a light of positivity where everything otherwise had seemed dark and never-ending. 

Often, when one begins to feel the positivity, they begin to shine and shed the positive warmth onto others. We often lose sight of how to do this when stressed, worn out, shaken to our core with a major life event, or losses of any kind. Re-center yourself so that you can feel that warmth again, and it's a healing one for you... and to those around you.

This is why -

To be able to feel the Sun, you must be the Sun. 

Reading Nutrition Labels: POTATO CHIPS

 

Today's blog is going to focus on a short quip about nutrition labels and how to read this for your best benefit:

1) Always check what the manufacturer considers one (1) serving size.

•     In this chips bag, 18 chips = 1 serving size = 140 calories.

•     There are a total of 8 servings per entire bag. This means, if I ate the entire bag, I ate 1120 calories in potato chips (140 x 8 = 1120). 

• Believe it or not, eating this entire bag of chips would be so easy to do while I'm watching Netflix mindlessly. 

2) Check what your sodium intake would be: 

• If you only ate 18 chips, you took in about 125mg of sodium 

• If you ate the entire bag, you just ate 1000 mg of sodium. This is about a 1/2 day's worth of sodium you should be eating. 

3) Check Fat content

• NO Trans Fats (partially hydrogenated oil) - GOOD!   

• Look at ingredients - use of vegetable oils such as Canola, Sunflower or Safflower are good sources of naturally occurring, non-hydrogenated oils and unsaturated fat.

• Limit sources of foods made with tropical oils (for example: Palm oil). 

4) Check Carbohydrate content (important for diabetics)

• If you are carb counting, make sure you double check this area

• 18 chips = 16 grams of carbs. Ingredient says made of potatoes - which has good nutrients, however, deep frying them and processing them into chips destroys important vitamins and nutrients, and simply adds calories.

• For a typical person watching carbs, you should try to keep each meal to around 45 -60 grams of carbs, depending on your current treatment plan. Since there is a limited intake of carbs - it's best not to simply eat only potato chips: highly nutritious foods such as fruits and vegetables and some whole grains should be in your day-to-day plan. 

• Your carbohydrate need changes based on activity level. Someone who runs a marathon will require much, much more of this fast energy. 

• Try to limit highly processed, refined carbohydrates and added sugars. 

Summary: 

Although this particular brand of potato chips chooses decent ingredients, potato chips should be eaten in moderation because they're processed, lack nutrition (many nutrients from the potato was destroyed during processing), are high in salt and fat (deep fried), and add calories! 

That doesn't mean they don't taste good. 

So eat in moderation - try to stick to the one serving size if you're eating this as a treat. Pair it with something nutritious, like an apple. Share the small bag or buy individual sized bags, and enjoy just once in a while. 

One serving size = 18 chips (per potato chip manufacturer)

COVID19 Vaccine Recommendations Update & Omicron Update

Vaccines:

Age 5-11 - vaccines (Pfizer only) have been available since early November 2021 - first series

Age 16-17 -vaccine boosters now available (Pfizer only)

Age 18 + - vaccine boosters now available (can mix-match any)

    6 month time interval minimum from Pfizer or Moderna first series.

    2 month time interval minimum from J&J dose.

Quick tips:

1) You can schedule your vaccines at most pharmacies - check their online schedules. Your physician's office may carry it too - give them a call. Hospitals and Health Departments also have clinics and pop-up clinics. Resources are available everywhere.

2) You can get your COVID19 vaccine with other vaccines (such as the influenza vaccine). 

• Those who had a strong vaccination response previously: you may want to consider separating the doses by a few days or a week, or plan for a few days of rest. 

• I highly recommend, that while your immune system is doing a lot of work doing its internal strengthening after vaccinations, it might be transiently low on resources, and you may get infected with a different respiratory virus. Take care of yourselves and allow your body time to recover. Try not not plan major trips, parties, large gatherings (including dining out), tough workouts after your shots. Give yourself about a week, mask up when you're out and about, hydrate well with water and feed your body proper healthy nutrition. Doing so may give your body the advantage and avoid some additional misery. (Please note: This is an opinion recommendation; there are no scientific studies to support this claim. This is a common-sense recommendation based on personal and patient experiences).

3) Remember that, if you're not allergic or have other medical reasons to avoid, you can take Ibuprofen or Tylenol after vaccinations to help with discomfort or fevers.

4) Vaccine critical adverse events are rare. Hospitalizations & deaths from COVID19 are preventable and significantly and tragically more common in unvaccinated individuals, young or old. 

Benefits significantly outweigh the risks in favor of getting vaccinated, and even more so now as millions of people around the globe have been vaccinated with one of the most well-vetted vaccines we have in history.

Vaccine side effects and a bit of misery after the vaccines: common. Expect a sore arm, feeling rather tired, some chills, headaches, and muscle aches or joint pain. Often improves after 3-4 days.

5) There is growing evidence from small studies that show that mixing or switching to a different booster dose version may increase your immunity level against COVID19.

Omicron Variant is now in Central Ohio

Still very few cases, but likely more of it in community, just unidentified. We ARE sequencing the tests that are going to the labs. The cases mostly have been mild so far, and we're thankful - however, that's not reason to not stay vigilant. We need more information - another 1-2 weeks to gather more data to see if this variant is going to be an issue.

Influenza cases are on the rise

Flu is not gone. We're starting the season. Many people are skipping their flu shots this season, and I empathize that this year, it just seems like we're standing at an assembly line waiting for the next vaccine.

Just had an Influenza positive test in my care population. CDC already seeing higher numbers this year than last year. Why?

Masks are off more often. Distancing is not happening as much. We're seeing some more pre-pandemic lifestyles than last winter. 

Suggestion? Be careful. Strongly consider the influenza vaccine. It is still a miserable infection and can still cause hospitalizations and pneumonia in some.

How to Prepare for a Visit with My Physician

Whether you are planning to come in for a wellness visit or discuss a new medical concern with your physician in-person or on a telehealth video conference, preparing ahead for the issues you wish to talk about may actually be helpful. 

From a physician perspective, here are some key points we are grateful for: