Do you have post-traumatic stress disorder? A traumatic brain injury? Both? If so, and you can’t seem to rein in the scattered thoughts that disrupt your day-to-day life, you might want to try meditating. Mindfulness meditation – mentally focusing on the present moment – helps alleviate PTSD, and TBI, symptoms. In a study conducted with a large group of marines, researchers had them participate in mindfulness meditation training while monitoring their blood pressure, heart rate, and breathing. Stress-related neuro-chemicals were also measured. Not only did researchers find that the marines were calmer during and after meditating, but they were able to react faster when faced with threats. In other, smaller studies, civilians with TBIs were trained in mindfulness meditation, and the findings showed that nearly sixty-percent recovered from depression. Participants also reported less anxiety and more energy.

Researchers don’t know exactly how mediation alleviates PTSD and TBI symptoms, but they’ve noted that it helps to reduce cortisol levels, a hormone associated with stress and depression. Meditation has also been shown to change the structure of the brain. Harvard researchers followed sixteen people in the general population who participated in an eight-week meditation program at the University of Massachusetts Center for Mindfulness. After completing the sessions, the researchers looked at magnetic resonance imaging studies of the participants, and found an increase in gray matter in the hippocampus, the part of the brain responsible for learning and memory, as well in the other structures linked to self-awareness. Since 1979, more than twenty thousand people have completed the program. 

A few years after being diagnosed with PTSD and a TBI, I tried meditating, with the hope of slowing down the mental chatter, and getting rid of the self-critical voice that said, “You’re incapable.” But I gave up after the first day – a cascade of unfocused thoughts kept colliding with the other, more steady voice in my head that said, Breath, breath in and out. I told myself I had failed at meditating. The irony is that, with practice, meditation helps you to accept your thoughts and feelings without judgment. Also, meditation is not some kind of futuristic, Brave New World model designed to erase all thoughts – that’s expecting the impossible. Meditation helps you to view your thoughts from a distance, as if you were standing outside of yourself, watching your thoughts pass by like clouds.

Two months ago, a friend told me she had started meditating five months earlier because she could not live with being self-critical at work and at home. “It’s changed my life,” she said. Her exuberance was powerful, powerful enough to convince me to try meditating again. My friend told me about Headspace, an accessible, user-friendly app for Apple iOS and Android devices. Andy Puddicome, trained as a Tibetan Buddhist monk, is the founder of Headspace, and is the soothing voice that guides users through each session. You can try it for ten days at no cost. After that, there’s a $12 monthly fee. The caveat: you need to pay for the entire year upfront. But Headspace is always coming up with offers: two months free, for instance. Once you complete the thirty-session foundation packet, you can choose from various themed packets: creativity, relationships, performance, sleep. And you can meditate anywhere – I recently meditated in an airport while waiting for a flight. It’s been two months since I started using Headspace, and it works. Though I still experience moments riddled with “I should” or “I can do better,” by focusing on my breath, or on the sounds and smells around me, I’ve learned to halt any out-of-the-moment thoughts before they completely unravel. Headspace has made me feel a bit lighter, as if a whole lot of mud has been dumped out of me.

Meditation takes ten, fifteen, twenty minutes at the most out of the day. Most likely you not notice a difference right away; the transformation is subtle. So give it time. After all, time flows, and it always flows forward, toward change.

Are you getting enough vitamin D? Low levels have been linked to depression, but researchers are now finding that vitamin D deficiency is also linked to psychiatric illnesses such as post-traumatic stress disorder. Vitamin D is formed from ultraviolet light and regulates calcium and phosphorus in the blood. Both of these minerals are essential for bone growth, and may help protect against cancer and diabetes. We need about fifteen minutes of sunlight a day to get an adequate dose of vitamin D, but wearing sunscreen (which is a good thing) blocks Vitamin D absorption. If you live in a state like Vermont, where the sun shines, on average, one hundred fifty seven days out of the year, you’re likely not getting enough vitamin D. You might want to try eating more foods with Vitamin D like cereals, milk, salmon and tuna. But food sources are usually not enough to provide the amount of Vitamin D we need per day. To see recommended doses by age click here. Though the upper safe limit of vitamin D is set at 800 IU per day, some sources advise we take as much as 1,000 IU a day if we are not getting enough sun exposure. But, as I mentioned in an early post about taking omega 3 supplements to treat a traumatic brain injury, it’s always a good idea to check with your doctor first. The only way to really know if you are low in Vitamin D is through a blood test.

A 2008 study of fifty-three psychiatric patients revealed low levels of vitamin D. Though this is a small sample, it adds to the research showing an association between vitamin D deficiency and psychiatric illnesses like PTSD.

Hopefully, these studies come as a relief to those of you with PTSD – now you have another option, other than taking anti-depressants, to treat your symptoms.

Are you in need of a service dog?

It is well known that people with physical disabilities benefit from service dogs, but emotional support dogs have yet to be scientifically proven to help those with post-traumatic stress disorder. Service dogs are trained to carry out specific tasks like guiding people with vision difficulties across the street, or picking up dropped items. Emotional support dogs provide companionship for those with mental health conditions. They are pets and not trained to do the tasks that service dogs are trained to do.

After previous studies were suspended, due to inadequately trained dogs, this past April the Human Animal Bond Research Initiative (HABRI) granted funds to Purdue University to measure the outcomes of utilizing service dogs for post 9/11 war veterans suffering from PTSD. Researchers will be working with K9’s for Warriors, a non-profit that follows a “Gold Standard” when training rescue animals to be service dogs. The study will assess for changes in stress level, medication, and relationships among veterans.

Though some private organizations provide service-dog training for individuals with mental health conditions such as PTSD, the Veterans Administration currently does not; they offer information on how to contact places that provide service animals. But they do offer veterinarian services. If the Purdue research proves that service dogs can help those with PTSD, the VA will also provide veterinarian care to those dogs.

The study will take several years to complete, but, who knows, maybe it will lead to more studies, ones involving service dogs for those with PTSD in the civilian community. Though such dogs are not to be relied on as a panacea for PTSD, if they are recognized as a legitimate adjunct to traditional treatments, thousands of people may benefit. In the United States alone, more than 24 million people are estimated to have PTSD at any given time.

Are you among the 24 million?

Are you interested in entering the nursing profession? If so, you could not have chosen a better time to do so. The fastest growing field in the United States is healthcare, with more than 3.5 million jobs projected to be added to the economy by 2020. One-third of that number will be registered nurses. If you are planning to go to nursing school, you may be interested in one of the more popular specialties: neonatal nursing, midwifery, or critical care. Or maybe you’re interested in military nursing. Nursing School Hub, a website dedicated to providing resources for those interested in the nursing profession, recently posted an info-graphic article, “The Military Nurse’s Toolkit.”

The benefits of being a military nurse may tempt you: loan repayment, world travel, and the opportunity to help a broad population. It goes without saying that military nurses face risks: physical injury by enemy combatants, and psychological stress from exposure to injured and deceased soldiers. If you have not read my post about PTSD and nurses, I encourage you to read it here.

If you are not interested in military nursing, but are eager to learn about nursing-related topics, such as scholarships, must read books for nurses, top nursing schools and jobs, and where to find a job, I recommend taking a good look at Nursing School Hub’s website.

Are you in search of a creative, interactive approach to treating post-traumatic stress disorder?

Several years ago, when horseback riding, I reached behind me for my raincoat that was strapped to the back of the horse. As I swung the coat toward me to put on, the horse bucked and started running. I panicked and forgot what I had learned a few moments earlier – not to hold the reins too tightly, which will only make the horse pull harder, or lean forward, which signals the horse to run faster. The guide, who was not far behind me on his own horse, yelled for me to let up on the reins and sit back. I took a few deep breaths and and did as he said. The horse soon slowed, then finally came to a gentle stop. After my heart slowed from a gallop to a trot, the guide explained to me that I had startled the horse with my yellow coat.

Soon after that incident, I went horseback riding again, and had a positive experience. Since then, I have not been on a horse; I’m not sure why? As I age, am I more fearful that I will get hurt? Yes. And living with PTSD has made me more fearful of taking unnecessary risks. So why would I even think about getting on a horse to trot through wild territory? But horses are extremely affectionate and accepting animals, and have a lot to offer human beings.

For more than fifty million years, horses have played a role in transportation, entertainment, farming, and more. By nature, horses are instinctive and highly alert and, therefore, equine therapy can help those suffering from PTSD symptoms like hyper-vigilance. Horses may not speak, but they do communicate by mimicking human emotions. For instance, if you are feeling anxious, horses will react by, say, widening their eye or flicking their ears. In other words, horses are our mirrors. Their non-verbal feedback is a prompt for us to better understand our internal processes. We can then modify our behaviors. The key is to be in-tune with how horses react when you are with them. Equine therapy has been noted to help with emotional healing: among a long list of benefits, it decreases anxiety, improves social skills, assists in better communication; and increases confidence, self-awareness, and trust.

I recently decided that, in order to confront my fear of horses, I need to get back on a horse soon. So that’s what I intend to do this summer.

If you’re interested in equine assisted psychotherapy program, check it out!

I recently had the pleasure to meet Dr. Gene Lindsey, a compassionate and empathetic physician for nearly four decades, who has been a guiding voice in Massachusetts concerning healthcare reform. To be fully informed about the latest happenings in healthcare, I encourage you to read Dr. Lindsey’s blog, where you can also sign up for his weekly newsletter Healthcare Musings. In an email exchange with with Dr. Lindsey, he shared with me his experience visiting his ninety-four-year-old father this past winter. Because I want to understand the aging process, and write about aging here on my website, his story intrigued me. My ninety-one-year-old father-in-law, Tom, passed away not too long ago. So, at this time, topics related to aging and loss are of particular resonance. Please enjoy this excerpt of Dr. Lindsey’s story, “I Can Do it Myself.”

This past February, I traveled to Lincolnton, North Carolina to visit my father and to share with him a celebration of what would’ve been my mother’s 96th birthday, if she were still alive.

My parents “retired” in late 1982 when my Dad turned sixty-two. After twenty-five years of “retirement,” my mother’s health declined in her late eighties, and my Dad transferred more of his time to her care. By 2006, caring for her became more than a full time job, and the medical resources to manage her various conditions didn’t exist in their community. They sold their home and bought one in the Atlanta area near my sister, whose daughter and daughter-in-law were both nurses. In Atlanta there were more specialists, with more services nearby. With the support my sister’s family provided, my parents were able to live independently. My mother survived another six years before she died in hospice care in 2013, two months before her 94th birthday.

During the last seven months of her life, after she enrolled in hospice, she lived a remarkably comfortable existence. Most of the hospice care was in their home – Mom received inpatient hospice care only when my father needed respite, and again at the end. The entire six years was a tour de force, organized by my Dad and sister.

The role of caregiver gave great purpose to both my Dad and sister until my mother died. Not only had my Dad lost his spouse, best friend, and confident of seventy years, but he lost his real purpose for existence. Dad had no social supports in Atlanta other than family. He was intellectually isolated because he had given up his work and social contacts to care for my mother. Despite many offers for grief counseling from hospice, he couldn’t connect in an effective way. 

Atlanta wasn’t the place for our Dad, but he couldn’t live alone anywhere else. In May 2013, we gathered in North Carolina at my mother’s grave to honor her on Mother’s Day. My Dad’s neglect of his health was most obvious by his instability on stairs that weekend and his story of a few “slips” at home. When he returned to Atlanta, he fell and broke his hip. 

The next six months were pretty dreadful and included a prolonged hospitalization. Our father didn’t want assisted living. My brother agreed to become a caregiver and live with him. He asked only that he and Dad find a home in Lincolnton that allowed each to have space for themselves, and that we figure out how to cover him so he could have a week each month at his home off the Georgia coast, to attend to personal business and spend time with his grandchildren.

To make such a decision is one thing. To execute the move and reestablish support systems is another. By the time of the move, my Dad had a mounting list of chronic issues – many were the result of inactivity from grief, but he still had a long list, including a cardiac pacer, residual problems from a total knee replacement, and late complications from surgery for prostate cancer.

Last May, a year after the broken hip, and as things were settling into a good rhythm in the new home with my brother, my father fell again when he tripped on a curb. He fractured his pelvis and spent six weeks in the hospital, including rehab. All the gains over the last year seemed lost.

The core issue was what part of his condition was due to memory loss and other cognitive issues and what part was situational depression and grief that might improve with the right combination of meds and rehab? Previous attempts to use psychotropic meds had been problematic. It became clear that the depression and cognitive issues would be best managed with counseling. Experience had taught us that the liabilities of meds for anxiety and depression in any but the most miniscule doses far outweighed their benefits.

Healthcare in Lincolnton had changed since my mother was forced to go to Atlanta for care. In the interim, the county hospital was sold to Carolinas Healthcare Systems, a growing non-profit system. My Dad hadn’t been effectively integrated into the system before his second fall, but he was by the time of his discharge from an affiliated rehab. Back at home, he was seen regularly in outpatient rehab, and his emotional and cognitive issues were effectively managed between his PCP and the larger system. When he visited me for a month in August, he could walk a half a mile with a rolling walker, if allowed many stops to rest.

Now, six months later, he walks a mile a day, with a sure gait, though he follows the advice of his physical therapist and never leaves home without his cane.

Earlier this past winter, he walked his daily mile on an indoor track of an athletic facility. Those 18 laps were “boring,” as he clicked them with a counter. Two months ago, an expanded supermarket opened in town, and he discovered that five laps around the perimeter inside the store was a mile. Now, while shopping, he counts his laps by shifting a coin from his left pocket to his right one at the end of each lap.

While I walked through the store with him during my recent visit, the lady in the flower section stopped us on three of our five laps: first to say hello and ask who I was, again to ask my father to pray for her friend who was having her kidney removed, and a third time to ask his advice about how to approach the store’s management about getting more work hours. My father had the time to chat, and enjoyed the opportunity to serve.

The real measure of his recovery is that he’s socially interactive with people outside his family and no longer talks about his life being empty of purpose. He’s active in his church, and writes Lenten essays requested by the minister. He has also spoken with the folks at the local hospice about volunteering and loves to attend “old philosophers” meetings at a fast food eatery most mornings. He’s developed an interest in a homeless man, who is seen regularly around town pushing a shopping cart full of his belongings.

The thematic high point of the trip occurred when we went to get in the car to drive to the store to go for a walk. I offered him a hand, but he refused my help with a curt yet logical: “I can do it myself. I will do it better this time than the last time I did it; and if I do it myself this time, the next time I try, I will be even better!”

I’m reminded of what I was taught in medical school: Grief is a two-year process. I’m also aware that many elderly people die in close proximity to the death of their spouses. I also believe that my father is the great beneficiary of the evolving body of information that’s leading to the improved care for the elderly. My Dad didn’t know how to ask for help and our efforts were well meaning, yet the job is hard and at times feels impossible. But hard is not the same as impossible, and I’m grateful for the medical professionals who appeared on cue when beckoned by a PCP who knows the family and the patient, and shows by his efforts that he cares.

The care my parents have been fortunate to receive, and the support their caregivers have been presented with may not be perfect, but all I need do is think back to the limited resources available not that long ago. The challenge now is to make care that is at least that good the right of every citizen, including the man wandering the streets with the shopping cart, who has a name and a history my father now knows.

Gene Lindsey, MD, CEO Emeritus of Atrius Health, served as President and CEO of Atrius Health and Harvard Vanguard Medical Associates from 2008 through 2013. Dr. Lindsey has been an internist and cardiologist for almost 40 years, practicing at Harvard Vanguard Medical Associates and its predecessors since 1975. He has a long history of leadership during that time. In 1997, when Harvard Vanguard Medical Associates, a non-profit, 500-physician multi-specialty medical group was created, Dr. Lindsey became the first Chairman of the Board for this new organization.  In 2004-2005, when five groups affiliated to form Atrius Health (formerly HealthOne Care System), Dr. Lindsey joined the Atrius Health Board, and in January 2007 became its Chairman, a position which he held until he was appointed as CEO. Dr. Lindsey served on the Advisory Committee to the Massachusetts Health Care Quality and Cost Council, Special Commission on Price Variation, and now serves on the Advisory Committee to the Massachusetts Health Policy Commission. Lindsey received his medical degree from Harvard Medical School and holds a B.S. in Chemistry from the University of South Carolina. He completed an internship, residency, and was a clinical fellow in cardiology at Brigham and Women’s Hospital. Dr. Lindsey is a sought-after speaker on the healthcare topics of payment reform, accountable care organizations, practice innovation, quality and efficiency.