Hello everyone,
I hope you're all doing well as October unfolds.
This week, I want to share some reflections and clinical pearls that came out of my experiences at the Integrative Medicine for Mental Health (IMMH) 2016 Conference.
I hope you will find it useful.
“My boy, you’ve got to remember it. You’ve got to remember the exact spot and the exact marks the boat lay in when we had the shaolest water, in every one of the five hundred shoal places between St. Louis and New Orleans; and you mustn’t get the shoal soundings and marks of one trip mixed up with the shoal soundings and marks of another, either, for they’re not often twice alike. You must keep them separate.”
When I came to myself again, I said:
“When I get so that I can do that, I’ll be able to raise the dead, and then I won’t have to pilot a steamboat to make a living. I want to retire from this business. I want a slush-bucket and a brush; I’m only fit for a roustabout. I haven’t got brains enough to be a pilot; and if I had I wouldn’t have strength enough to carry them around, unless I went on crutches."
Life on the Mississippi by Mark Twain pp 43-44
This is one of my favorite quotes of all time. I can really relate to it, having been through medical school, residency, and many conferences since. One would think that, after 14 years of experience in integrative medicine, I might be able to finish a conference feeling positive about my level of expertise. Let that hope be buried forever. No, I am doomed to feel as Mark Twain did in the quote above: overwhelmed, humbled, and feeling “only fit for a roustabout.”
It is true, as Albert Einstein said, “The more I learn, the more I realize how much I don’t know.”
After the last day of the conference, as I arrived at Sweetgreens, a salad restaurant, alone, feeling dejected and somewhat sorry for myself, I saw two other attendees sitting at a table. Putting on a smile, I asked if I could join them, and they graciously included me. As we started chatting about the conference, we began to talk about integrative medicine and patient care.
As I shared with them my clinical experiences in psychiatric care, their eyes lit up, and they began to ask me questions about all the things that I actually knew. As I shared what I knew, I felt like a fount of wisdom. One woman said, “Thank you so much! This is the best part of the conference!” And so life teaches us to be humble, but also to be aware of the wealth we carry, so that we can learn to share as comrades along our journey.
Here are some clinical pearls from the conference:
1) The importance of slowing down our breath: breathing 5-6 breaths per minute improves the heart rhythm, strengthens the parasympathetic nervous system, relaxes the body, and supports healing. On the other hand, avoid rapid, forced breathing, or holding one’s breath, because it can induce anxiety and even seizures. The ideal “dosage” is 20 minutes twice daily.
2) The gut-brain connection: in repeated lectures, we were taught about the importance of a healthy gut for proper mental health. The critical nature of the gut microbiome system was also illustrated recently in my clinical work, when a patient’s mental health suddenly deteriorated rather mysteriously.
She had been lowering her psychotropic medications and had been doing very well for many months. The process had been described by her mother as “miraculous.” As I tried to figure out why the patient was suddenly not doing well, the mother informed me that the patient had stopped taking Nystatin abruptly, a medication to reduce fungal growth, about two weeks ago, and she had forgotten to tell me about this change.
The recommendation came from another holistic doctor, who had prescribed Nystatin in the first place. After some diagnostic testing, I decided to put the patient back on a slightly lower dosage of Nystatin. Within a week, the patient’s mental status stabilized. What was interesting was that the patient had a bad case of sinusitis during her recovery. I had read that chronic sinusitis is often associated with fungal growth in the sinuses. So, I suspect that stopping the Nystatin not only increased the fungal problem in the gut, but also in the patient’s sinuses.
3) The harmful role of Statins and the importance of Cholesterol: a whole lecture was devoted to the scientific evidence against the use of Statins. Much was shared about the dangers of having low cholesterol levels. Anything below 160 increases health problems exponentially. For older individuals, a cholesterol level of 100 increased the death rate to four times higher than having a cholesterol level in the 220’s. What an amazing thing to learn!
The use of statins worsens memory and increases irritability. Its preventative benefits are minuscule and pale in comparison to proper diet and exercise. Bottom line: avoid taking Statins. The scientific and clinical data do not support its use.