A Voice in the Night

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bicycle-hd-wallpapers-2012It was a typical January night in Kittitas Valley: a chilly twenty degrees, scattered snow flurries, and plenty of snow on the ground. Fortunately the roads were mostly bare however, and I was able to be on my bike commuting to work.

While riding my bike home from a day at work, I like to notice my surroundings as I roll by, while at the same time think about the day’s events. It sometimes seems to be a little bit of a balancing act between paying attention to the here and now as well as thinking creatively about work or home.

I think I was in the midst of the later thoughts – creative daydreaming as I like to think of it, when a large pickup truck slowed down, pulled alongside me, and rolled down its passenger side window. In general, while riding my bike and a vehicle – especially a big one – slows down alongside me, I get a little nervous. A truck is big and a bike is little; meanwhile, the notion that this was at night as well as it was a large truck heightened my senses, and made me feel a bit uneasy.

“I appreciate your interest in safety, young man,” a man’s deep voice came clear and loud through the window. Looking into the cab, all I could see was darkness.

Somewhat surprised and not sure what to say, I said, “alright!”

Just as clear and deep, he replied, “thank you.”

“Sure!” I said, still struggling somewhat as to how to respond.

He accelerated and drove off into the night.

Over the past few months I had upgraded my rear light system to improve my visibility, and my lights must have been be working!

I rode on, following my familiar route home. The interaction made me feel really good. It is always nice to be appreciated. The driver didn’t need to slow town and interact with me, but he did. He took that extra step to be friendly, put out some good energy, and appreciate something I was doing.

I rode a couple more miles, thinking about the interaction more, and it occurred to me that there was an additional aspect of the interaction I liked. He said, ” young man.” I am not exactly a young man, but he couldn’t tell.  It was dark and I was wearing multiple layers of clothes and a bike helmet. He assumed I was young because I was commuting home on my bike.

I rode a few more miles, thinking all the while about the interaction. He thought I was young because I was doing what many consider to be a young person activity – riding a bike rather than driving. Meanwhile, riding my bike – exercising – was in fact likely helping to keep my body young. Hmm. I was perceived as young because of the activity I was doing. Chronologically I am not young; but, by doing the activity, I was promoting physiologic youth. I liked the full circle of these thoughts.

That January night I was reminded how good it feels to receive an appreciation, and how important it is to give appreciations. I also received an affirmation of how exercise, regardless of age, promotes a “youthful” state of health for the body and mind. I received these gifts because an individual made the effort to notice, slow down and say thanks.

Resilience Tools, On Line and Available

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Resilience:

  1. The power or ability to return to the original form, position, etc., after being bent, compressed, or stretched; elasticity.
  2. Ability to recover readily from illness, depression, adversity, or the like; buoyancy.

As anyone who has experienced a serious illness or injury can attest, a health crisis creates a sense of being bent, compressed, or stretched, coupled with an intense longing to return to one’s original state. Resilience is elasticity: it is bending but not breaking, being compressed but not flattened, and stretched but not torn. Cancer, injury, or any serious illness, can drag one down– often abruptly– into the murky depths of illness. Resilience is buoyancy: the ability to rise up, resurface and emerge into sunlight and fresh air again.

Having resilience during a health crisis is adapting well in the face of adversity; it is “bouncing back” from difficult experiences. Resilience requires the ability to enlist one’s own emotional, mental and spiritual strengths, and implies a sense of activation and internal motivation. For example, resilience is not closing and bolting the door and waiting out the storm. The sense of bracing or shielding from adversity is more typical of “perseverance.” Perseverance is important and can be helpful, but it is not the same as resilience.

It is this sense of action from within that conveys there is something we can do to create resilience in our lives. Resilience is not inherited; in fact, research has shown that behaviors and decisions are much more powerful than genetics in developing resilience.

Early on in my journey with cancer I was introduced to CaringBridge, which helped nurture resilience within me. CaringBridge is a nonprofit organization that enables a person or family experiencing a health crisis to create a free website. This personal website facilitates connection to loved ones. When I had cancer, I was able to communicate with my family, friends, and larger community, and they in turn could communicate with and support me. In addition, one can keep an online journal to share the logistics as well as the emotional experience of a medical journey.

The diagnosis of a tumor in my muscle was an abrupt detour on the road of life, and like many others who experience similar news, my initial response was fear and worry about the future, as well as a sense of isolation from the “normal” world most people seemed to be living in. Having resilience is associated with social connections. Individuals who feel a sense of connection and support from others are more likely to adapt well to an illness, and are more likely to recover more quickly. CaringBridge is an online medium that easily connects individuals with a support group.

Research has also shown that expressive writing and a concept called “mindfulness” help promote resilience. Initially, I had no idea that keeping a journal on CaringBridge about my treatments, experiences and struggles would have such a profound effect on my ability to cope with my illness. Writing about a difficult experience helps one gain new insights and perspectives, reflect, as well as see and articulate the positive aspects of a difficult experience. As a story is shared, someone in the midst of a health crisis not only communicates what is happening, but also may see the opportunity to influence the direction of their own narrative. Over time this expressive writing can subtly encourage the creation of a new, more hopeful reality. My personal CaringBridge journal began as an avenue for communicating information, and gradually evolved into a journal that shared a variety of emotions I experienced, and expressed gratitude for the multitude of people in my life who provided immeasurable support. Writing helped me reflect and better understand my journey; writing gave me strength.

Since expressive writing is an in-the-moment process, it can also encourage staying in the present. The present is the best place to be during a serious illness. Thinking about the future when one is scared is often fraught with the worry and anxieties of “what-if’s,” which can then lead to more and darker “what-if” scenarios. Meanwhile, lingering in the past can foster a sense of loss about a life that is lost, or lead to the “should-have” and “could-have” thoughts that impede adapting in healthy ways. Staying in the present is the essence of “mindfulness,” and has been shown to promote resilience.

I learned that the antidote to the fear and isolation that can occur with a serious health event is connecting with others, opening up rather than hiding, sharing, and staying in the present. Through writing and social connection, CaringBridge gave me tools that promoted resilience when my world turned upside down.

If you know of someone experiencing a serious health crisis, introduce them to CaringBridge. In doing so, you will help equip them with valuable tools that foster internal elasticity and buoyancy. You will increase the chances the person you care about will respond to their illness in adaptive ways that promote healing. In sharing the gift of connection, the seeds of resilience are sown, nurtured, and are given opportunity to flourish.

Listen to Dr. Merrill-Steskal’s interview with CaringBridge Founder Sona Mehring.

What’s in a Name?

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How can we know when seemingly insignificant events in our life will impact our lives in ways we do not foresee? We can never know; it is only years later, when we look back and gain perspective do we gain appreciation.  The experience I would like to share was not earth-shaking or what one might describe as particularly profound; rather, it was merely one of those light, amusing life experiences.  Nonetheless, it was an experience that I recall with a smile, and an experience that has helped my vision in naming this blog.

It was 2006. My wife, son and I stepped forth from our rented apartment on the first day of a long awaited trip to Italy. Gabe had been studying the Renaissance in his elementary school “challenge class” and Anne and I had, in the distant past, both had formative experiences in childhood or college while in Europe. It had been many years since we had been in Europe, and it was Gabe’s first time.

It was a bright beautiful morning in May. We walked down a bustling street in Rome, and looking for a place for breakfast, we spied a busy cafe and entered to sights of wonderful looking pastries and the rich smell of espresso. We pointed, smiled and attempted a word or two of very rudimentary Italian to indicate which pastries we were interested in. And then I ordered my coffee.

Anyone who knows me knows I like coffee. I drink a fair amount of coffee, but it is not as though I drink pots and pots of it.  I like it strong, I like it black,  and I like it in those tiny little espresso cups so I can savor it, nice and hot.  Upon first glance at the small espresso coffee cups in the Italian cafe that day in 2006, it was quickly apparent to me that even a “double” espresso was not going to be adequate; so I ordered a “triple.”

“Tre?! Tre?! No, doppio. ”  The Italian man said, shaking his head emphatically.

I learned right away that a “triple espresso” was not allowed. Judging by the look of surprise in his eyes, it was as if I had asked the impossible. It was single or double. I attempted to explain that I really did want a triple espresso; but no, sorry, a triple was just not an option.  I ordered a double (doppio) espresso, enjoyed it immensely, and  then went on to order another double espresso.

This experience was one of those funny little events that happen while traveling. I’ll never forget the look of surprise in the Italian man’s face as I asked for that triple espresso. I didn’t know it at the time, but the stage had been set for “Triple Espresso MD” to be born. Not long ago,  Anne and I were bouncing different names for the blog off each other, and perhaps because we were once again traveling in Europe, in a moment of inspiration she exclaimed, “Triple Espresso MD!”  It was instantly clear she had hit upon the perfect name for my blog.

I think it is safe to say that proposing a “triple” espresso that day in Rome was not exactly a brilliant insight or a think-outside-the-box new idea. I merely wanted what I thought was an adequate amount of coffee. Still, “triple espresso” symbolizes to me an attempt to look at issues a little differently, from a fresh and creative perspective. In addition, the name is imbued with a sense of humor and makes me smile. And of course, lets not forget that espressos are packed with energy; it is my hope that this blog energizes readers to live a healthy life.

“Triple Espresso MD” is a place for creative and fresh perspectives on health and medicine. I you enjoy it as much as I enjoy my espresso!

Lost Stories

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img_2661Not far from the busy pedestrian streets in the center of Vienna, down a quiet narrow street, lies a small cobblestoned city square. Before World War II, this city neighborhood was the bustling, vibrant heart of Vienna’s Jewish Quarter, but today it is has a quiet, almost subdued feeling. Vienna’s current Jewish population is only a small fraction of what it was before the war, and the quiet feel of the square reflects this.

At one end of the square is a memorial to the thousands of Jewish individuals who lost their lives during the Holocaust. At first glance, the memorial looks like a huge square concrete block, oversized and awkwardly placed in an otherwise well-proportioned city square. As one approaches however, the details become more clear: the memorial is a library of books. But in contrast to how books are normally displayed, the books are turned inward such that the spines are in the center of the concrete block, hidden from view. Walking the perimeter of the memorial, the observer sees only the outer edges of the pages – no spines to reveal the titles or authors.

To view this memorial is thought provoking and very moving. The library symbolizes the lost stories of the Holocaust: humanity lost scientists, poets, artists, musicians, teachers – countless unique individuals who possessed knowledge, gifts, and skills that could have added to the diverse richness of humanity.  A library of humanity, knowledge and gifts, hidden from view and lost forever.

The image of the Jewish Memorial and the feelings it brought forth washed over me as I read about the many ways in which the medical profession – and human health – has benefited from the natural world. Many important, life saving medicines are derived from plants and animals in nature. For example, blood pressure and diabetes medications, cancer treatments, and blood thinners all are derived from chemicals discovered within plants or animals. In addition, modern medicine has looked to the natural world for inspiration and models for many significant advances.

However, this rich and diverse fund of knowledge – this library – is disappearing at an alarming rate. Biologists warn that Earth is losing species at an unprecedented rate, such that our current era has been called “the sixth extinction.” With every lost plant or animal, humanity  loses unique tools, lessons and examples that could help human health. In addition, as we lose biodiversity, we also become less able to adapt to changes in our environment, becoming handicapped in our ability to respond to new diseases.

Much of the Holocaust occurred while the world’s nations looked the other way, ignoring the unprecedented loss of life. Similarly, as species disappear on a daily basis in today’s world, most of us go about our daily life, attention turned elsewhere.  Humanity can not afford to ignore this destruction of the natural world. Human health will increasingly suffer from the loss of knowledge the natural world offers, and just as countless human stories were lost during the holocaust, we will lose the stories from nature that could help us live a healthy life.

There is not a simple solution to halt our current loss of biodiversity, but we all must do what we can. Every little bit helps; we can drive less, recycle, and support  laws, politicians, and businesses that value the environment, for example.

The time for action is now. The health of the natural world and the health of humans are intimately intertwined, and ultimately will enjoy or suffer the same fate.

Interconnectedness And The Flu Vaccine

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vaccineI received my flu shot the other day. I love getting vaccines. Vaccines prevent disease and help keep me healthy. To me, getting that poke in the arm gives me a feel-good sense of interconnectedness with others. I know it seems at first a little odd to make this comparison, but for me it’s true. Getting a vaccine helps keep me well, and makes me happy knowing that by not getting the flu I am keeping others healthy. Not only do I feel cared for as an individual, but in getting that shot, I enjoy a sense of caring for others.

And when it comes to caring about our community, kudos to our own Kittitas Valley Healthcare organization for working hard to prevent patients from getting the flu. KVH has adopted a very strong influenza vaccination policy, in that if a KVH employee chooses not to get the influenza vaccine, they are required to wear a mask throughout the flu season (from November 1st through March 31st!).

Getting the influenza vaccine as a healthcare worker is very important; research has shown that healthcare workers who get the flu risk infecting their patients, which can result in serious illness and death. For example, research on this topic has compared nursing homes with high rates of influenza vaccination among staff to nursing homes where staff had lower rates of vaccination. The nursing homes that had low staff influenza vaccination rates had significantly higher influenza related deaths among the residents. In other words, getting the influenza vaccine not only keeps healthcare workers healthy, but protects the people they care for.

Similarly, when a individual in our community gets the influenza vaccine, they not only  improve the chances of not getting the flu themselves, but also of not giving it to others they come into contact with. Regardless of our profession or daily activities, we inevitably interact with other community members, some of whom may have medical conditions that make them more vulnerable to getting sick with influenza. For example, it’s almost impossible to know if the person we stand in line with at the grocery store has cancer and is taking medicine that suppresses their immune system. Why take the chance of getting someone else sick?

My advice is to take action to keep yourself, friends, family, and fellow community members healthy. Get the influenza vaccine. In addition to being healthier, by receiving the vaccine you promote the health of others. Take a moment to reflect upon what that vaccine is doing not only for yourself, but for every person in your life.

Gun Violence: A Public Health Crisis

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We can use the scientific process…to help us learn how firearms can be safer. 

The numbers are daunting. Over 33,000 people die from guns in the United States each year, more than any other industrialized country.  The homicide rate in our country is twenty times higher than countries similar to ours. While mass shootings are occurring at increasing frequency and dominate newspaper headlines, most deaths –two thirds– are from suicide.  And perhaps most disturbing is that children less than 18 years old in America die from guns at a rate that is eleven times that of other countries; suicide is the second most common cause of death for our youth.

I tend to look at health and medicine from an optimistic, “glass half full” perspective. For most health topics, I find it relatively easy to take this perspective.  However, it is difficult to do so with gun violence.  Put bluntly, there is nothing good guns do for human health. Every death from firearms is tragic, sudden, and disturbing. Every death from firearms did not have to happen.

I also like to look at health recommendations from what is considered an “evidence-based” perspective. “Evidence- based” means that recommendations are based on scientific evidence and research. The scientific process attempts to look at questions from an objective viewpoint, and continually reevaluates previous conclusions to confirm their accuracy. Using science to guide us is our best chance at knowing what “works” for health problems.

Americans own more guns per capita than any other industrialized country in the world. Meanwhile, the second amendment protects the rights of Americans to bear arms. These facts will not change. What can potentially change, however, is the creation of a safer environment in which guns and people coexist. My hope– my “glass half full” perspective–  is that by approaching firearm safety as we have other public health issues, we can come together as a nation and take rational, evidence based actions to reduce harm from firearms.

By reviewing past public health challenges, our country can learn how to reduce deaths from firearms. A good example is how we have approached harm caused from motor vehicle crashes. Because of research studies, we learned that wearing seat belts and having airbags save lives. Meanwhile, the statistics have overwhelmingly supported the notion that driving intoxicated increases the risk of being killed — and killing others– in motor vehicle crashes. As a result, laws were enacted that required cars to be made with airbags, drivers to wear seat belts, and that have enforced not driving intoxicated. Even more importantly, because of what has been learned through research, driving culture has changed. It is not acceptable in our country to drive drunk or without a seatbelt. In other words, research illuminates important health and safety facts, laws support those facts, and behaviors change.

Similarly, if we ask questions and arrive at answers through objective research studies, we can use the scientific process as an important tool to help us learn how firearms can be safer in the United States. Already we know that gun safes and locks reduce suicides and accidental shootings in the home, but we need to learn more. We need to use scientific, evidence-based research to learn what other interventions can help make the presence of firearms in the home safer.

In our current era of political divisiveness, it is time to come together as a country to reduce gun deaths. Gun violence in America is a complex problem and solutions are often not simple, but if we approach this topic as we do other public health topics, and utilize an evidence-based perspective, as a country we may be able to make progress in reducing the number of deaths each year from firearms.

Listen in on my discussion with Dr. Mark Larson on “Gun Violence as a Public Health Problem”.

Above the Clouds

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cloudsRecently I was graced by the presence of a friend who is in the midst of battling cancer. It was a very special privilege, a reminder of how precious we each are, and how every day is a gift.

To have an aggressive or advanced cancer and to meet it head on transports that person and their loved ones into a different state of being. Most people not facing a life threatening disease go about their daily life with an underlying sense that the future is measured in many years. There is time to think about what might happen next year, to plan for retirement; there is time to day dream about the future. But cancer changes all that. What is important is now: family, friends, the warm sun and the beautiful blue sky. Now is so very precious and important. Now is the time to tell your spouse you love them, to notice and share the beauty in your child. The present is alive with the beautiful energy of life and love. It is almost as if the people without cancer are living on the surface of the earth, below the clouds on a partly sunny day, while those absorbed in the intensity of living with cancer have the opportunity to rise up and see those clouds not from below, but from above, to experience the radiant blue sky and the brilliance of the tops of white clouds and bright sunlight.

I know this heightened awareness of living, as my life was once acutely threatened by cancer. I felt uncertainty and fear, but when I was able to move through and above those feelings, I experienced a clarity of perspective, a vivid awareness of the beauty of life. I know it, I have lived it, but am not there now. As far as I know, if my good fortune continues, I am free of my cancer. Over the past couple of years, I have gradually rejoined the cancer-free crowd, and as such have slipped into the inevitable routine of thinking and feeling too often into the future. Because I am not acutely threatened as I once was, I have slipped out of that special, heightened state of being. I love to appreciate the present and try to take nothing for granted, but it is not the same. There is no substitute for the real thing.

Spending an hour with this very special person who was immersed in the cancer experience, whose eyes sparkled as she smiled at her daughter and told her husband she loved him, was truly a gift. It reminded me of my experience, and how important it is to strive – all of us – to experience and appreciate life to the fullest. Just by trying, we can make our lives and the lives of those around us that much more close to that special, almost divine, state of being.