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Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss Larry Bergstrom MD FACP Integrative Medicine Division of Consultative Medicine.

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Presentation on theme: "Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss Larry Bergstrom MD FACP Integrative Medicine Division of Consultative Medicine."— Presentation transcript:

1 Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss Larry Bergstrom MD FACP Integrative Medicine Division of Consultative Medicine (CMED) Mayo Clinic Scottsdale AZ Joanne Cacciatore, PhD Arizona State University School of Social Work

2 Goals and Declarations 1) To define Integrative Medicine 2) To recognize the Medicine Wheel of Health 3) To know the three basic elements of health Declarations: None

3 “Our greatest glory is not in never falling, but in rising every time we fall.” Confucius Confucius

4 Stress A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation Stimulates Sympathetic Nervous System Adrenaline Cortisol Increases blood pressure, heart rate, affects coagulation system, immune system, blood sugar, sleep

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10 An Exercise: Rate Your Stress Scale: 1-10, 10 is worst stress

11 An Exercise: Rate Your Stress Scale: 1-10, 10 is worst stress Includes health, finances, family, neighbors, in-laws, work, global warming, politics, etc.

12 An Exercise: Rate Your Stress Scale: 1-10, 10 is worst stress Includes health, finances, family, neighbors, in-laws, work, global warming, politics, etc. How much of the day do you think about things on your stressor list?

13 Rate Your Stress 1/10- Perfect idyllic life 5/10- Saber-toothed tiger is in the neighborhood somewhere 10/10- He’s breathing in your face

14 Conventional Treatment of Stress

15 Potential Complications of Chronic Stress Heart disease Sleep problems Digestive problems Depression Obesity Memory impairment Worsening of skin conditions, eczema

16 Mortality and Bereavement Question: Does death of a child increase mortality of the mother?Question: Does death of a child increase mortality of the mother? 69,224 mothers age 20–50 from National Longitudinal Mortality Survey, 9 yr follow-up,69,224 mothers age 20–50 from National Longitudinal Mortality Survey, 9 yr follow-up, Results: Death of a child increases risk of death of mother by 133% especially in first 2 years. Not related to mother’s education or marital status, family size, the child’s cause of death or the gender of the child.Results: Death of a child increases risk of death of mother by 133% especially in first 2 years. Not related to mother’s education or marital status, family size, the child’s cause of death or the gender of the child. Espinosa, J. Econ. Hum. Biol. (2012),

17 Conventional Medicine Focuses on treatment of physical disease, defined by measureable parameters; physical exam, lab tests, imaging, pathology, etc. Successful treatment is eradication or amelioration of the physical disease Ideal for acute care

18 Definition- Integrative Medicine Comprehensive system that emphasizes wellness and healing of the whole person as major goals, above and beyond suppression of a specific somatic disease. Views the patient as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. BMJ. 2001;322:

19 Integrative/Integrated Medicine Combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness. National Center for Complementary and Alternative Medicine website

20 Integrative Medicine Consultation Review: Medical condition(s) Conventional Medical Therapies Patient’s past and current use of CAM therapies. Potential interactions of CAM therapies with Conventional medical therapies Discern patient’s attitudes towards potential therapies; the patient’s value system.

21 Integrative Medicine Consultation Develop an Integrated treatment plan incorporating: Exercise Nutrition Stress reduction Complementary and Alternative treatments tailored to the patient’s value system. How can we make the patient healthier?

22 The Medicine Wheel -Physical Health This is Western, Conventional medicine, defined by measurement Examination X-rays Blood tests Tests give us name of the disease which we then treat the disease; however, what about when all tests are normal?

23 Disease dis·ease A disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors

24 Patients suffer illnesses which are discrepancies between states of being and perceived role performances. Illness

25 The Medicine Wheel -Emotional Health Emotional Health Interface of Stress and Health through the sympathetic nervous system. “Fight or Flight” Saber-tooth Tiger analogy Patient rates stress level from 1 to 10, low to high

26 The Medicine Wheel -Emotional Health Coping skills learned when younger are used to deal with stressful situations. Many people are: Perfectionist People pleasers Ultra responsible Theme- “need for control”, “lack of trust” Very difficult to say “no” to anyone Black and white thinking

27 The Medicine Wheel -Emotional Health Mind-Body Medicine: enhance the mind's capacity to affect bodily function and symptoms. ↓ physical effects of Stress. Prayer Meditation Yoga, Tai Qi, QiGong Biofeedback Breathing Techniques Exercise

28 Rumination Inward:Ruminating about the past: Regret Anger Ruminating about the future: Fear Anxiety Outward Living in the present In front of you Focused on the moment

29 Mindfulness “Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.” Jon Kabat-Zinn

30 Mindfulness Exercise Take 5 minutes Pen and Paper Find a peaceful and relaxing picture Describe what you see in a non- judgmental manner Write it down

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32 Therapeutic use of slow breathing Many favorable effects on the cardiovascular system and respiratory function Decrease in vascular resistance: BP Increase in peripheral blood flow Improved exercise tolerance Induce a sense of calm Decrease anxiety

33 RESPeRATE Proven in 10 clinical trials to lower blood pressure naturally. No side effects except for relaxation. Reduces stress

34 Heart Math

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37 Combining Mindfulness and Paced Breathing Think “I Am” Breath in 5 Seconds Think “At Peace” Breath out 5 Seconds 6 Breaths/Minute

38 The Medicine Wheel Mental Health Neurochemistry- Psychiatry Target symptoms sleep appetite concentration energy sex drive Anxiety may be separate biochemical disorder Treatment- Antidepressants, correction of sleep disorder

39 Target symptoms of Acute Grief/Depression Sleep disturbance Appetite disturbance Concentration difficulties Poor energy Stamina initiative Loss of sex drive Passive death thoughts Hopelessness

40 The Medicine Wheel Spiritual Health History question: Do you have a spiritual part of your life that is helpful to you? What gives your life meaning? Defined by the patient. May be religious but not necessarily

41 Spiritual Effect of Illness Meaning Practices developed during health satisfying, fulfilling, enjoyable “charge our batteries” Illness, life changes may prevent engaging in them Deprives of energy, enjoyment, sense of control Can’t live up to self-expectations

42 Spirituality The question: “Do you have a spiritual part of your life?” “What gives your life meaning?”

43 Spirituality Activities developed during health Satisfying, fulfilling, enjoyable Charge up our batteries May all be lost through accident, illness other life changes and lead to a “spiritual crisis”

44 What gives our life meaning? Work Faith Family Hobbies Volunteering Pets Art Sports To be a parent

45 Spirituality In Short: “Why do you get out of bed each day?”

46 Spiritual Effect of Illness The Reality of illness- State of health with illness/disability. When one is unable to do the things that give life meaning. The Ideal- State of health when one is able to do what is needed to feel fulfilled and give life meaning. Developed during period of health “Spiritual Crisis”

47 Meaning and grief- Case 1 50 y/o women 6 years ago, adopted son, age 13, killed while riding his bicycle She grieves but remains positive “I miss him terribly but he was a gift that I would not have otherwise. I am grateful for the time he was here.”

48 Meaning and grief- Case 2 45 y/o man 3 y/o daughter died 5 years ago He decided no God could allow such a thing to happen Deacon but abandoned his church Divorced Became a Hedonist- lives for pleasure only, because there is nothing beyond what we can see.

49 Resilience A dynamic process (not a personality trait) encompassing positive adaptation within the context of significant adversity. Resilience is the result of individuals being able to interact with their environments and the processes that either promote well-being or protect them against the overwhelming influence of risk factors

50 Resilience The process by which we find new things to give our lives meaning when the prior ones are unavailable or no longer possible

51 Resilience and Outcomes Better physical health Lower anxiety and depression Well being Higher meaning in life More adaptive neuroendocrine response to stress Greater problem focused coping Kobasa S.C. et al. J Psychosom Res 1985; Maddi S.R. Am Psychol 2005; Hull J.G. et al. J Pers Soc Psychol 1987; Brosschot J.F. et al. Psychosom Med 1998; Maddi S.R. et al. Am J Drug Alcohol Abuse 1996

52 The Medicine Wheel -Community Community We do not live our lives in isolation; our community should be as supportive to our health as we are to theirs. Community is the background to the Medicine Wheel.

53 The Medicine Wheel -Community Community We do not live our lives in isolation; our community should be as supportive to our health as we are to theirs. Community is the background to the Medicine Wheel.

54 Integrative Medicine Shift question from: “How do we treat your disease? to “ How can we help you become healthy? Patient-centered Outcomes research- What is most meaningful to the patient?

55 Integrative Medicine Grief Five fundamental needs Exercise Nutrition Hydration Rest Social support: main variable in determining high vs. low grief.

56 Cumulative Survival time based on ↑ or ↓ changes in exercise capacity after exercise training and ↑ vs ↓ baseline psychosocial stress Milani 2009 Exercise for You

57 Integrative Nutritional Plan Utilizing food as a source of health and energy Emphasis is on food first Supplements are supplements to food Supplements are used to fill in where diet cannot cover everything. Mediterranean/Anti-inflammatory diet

58 Nutrition- Mediterranean Diet Pyramid

59 Mediterranean Diet Fish- (wild ocean) 3 x weekly Fish oil- EPA + DHA = 1000 mg daily Fiber- 35 gm/d Olive oil (Canola oil- high temp cooking) Whole grain products (less processed) Soy- Soy milk 8 oz, tofu 3 oz, soy nuts, edemame (isoflavones) Nuts- walnuts, pecan, almonds (Sterols)

60 Mediterranean Diet Fruit- dark skinned fruit (Flavinoids) blueberries, blackberries, purple grapes red wine, purple grape juice 2-4 oz/d grape seed extract Vegetables- ½ of diet, Not all greens! Green tea 3 c/d (EGCG)

61 Mediterranean Diet Lean meats- chicken (without skin) Red meat- (4 legs, hooves) eat once a month at most (source of omega 6) Probiotic- yogurt, kefir, probiotic supplement Avoid Partially hydrogenated oil (trans fat) High fructose corn syrup

62 Supplements Mood, Anxiety, Sleep Inositol- may help depression, panic, OCD. 6-8 gm 2x/d SAMe- may help depression, athritis. Dose mg 2x/d. may take 2 months to work. Do not take with antidepressants or if have bipolar disorder 5-HTP- may help depression mg/d, may help sleep

63 Supplements Mood, Anxiety, Sleep St. John's wort- may help mild to moderate depression. 300 mg 3x/d. interacts with many medicines Kava- may help anxiety. 100 mg 3x/d. May not be safe (liver failure) Passionflower- may help anxiety and sleep. 45 drops or tea or 90 mg tab.

64 Supplements Mood, Anxiety, Sleep Skullcap- may help anxiety and sleep. Tea or alcohol extractSkullcap- may help anxiety and sleep. Tea or alcohol extract Theanine- may help anxiety.Theanine- may help anxiety. 200 mg/day Valerian- may help sleep.Valerian- may help sleep. extract mg up to 2 hours before bedtime Lemon balm-may help sleep. tea from flowersLemon balm-may help sleep. tea from flowers

65 Supplements Mood, Anxiety, Sleep Chamomile tea- may help sleepChamomile tea- may help sleep Hops- may help sleep. dose/?Hops- may help sleep. dose/? Lavender- may help sleep.Lavender- may help sleep. tincture (1:5 in 50% alcohol) 60 drops/d Melatonin- may help sleep. Take 1 hr before bed, dose 1-20 mg, take biggest dose tolerated without side effect, take x 6 wks. Quit if no benefit.Melatonin- may help sleep. Take 1 hr before bed, dose 1-20 mg, take biggest dose tolerated without side effect, take x 6 wks. Quit if no benefit.

66 Questions for you Are you eating regularly? Are you skipping meals? Are you losing weight? Are you putting on weight? Is your refrigerator well-stocked? Are you shopping for empty calories and avoiding food that your body needs?

67 Positive Thinking and Grief positive thinking was inversely related to measures of depression, anxiety, and traumatic grief symptomatology Findings- Among bereaved individuals, low positive thinking is a cognitive feature of depression that is relatively independent of anxiety and traumatic grief symptomatology.

68 Intentionally interpret life with higher principles: Daily Themes MondayGratitude TuesdayCompassion WednesdayAcceptance ThursdayHigher Meaning FridayForgiveness SaturdayCelebration SundayReflection / Prayer

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