FRIDAY THE 13th

You don’t have to be superstitious to at least give a passing thought to the fact that it is Friday the 13th and a full harvest moon. While Love and Medicine raises a skeptical eyebrow to such folklore, I like to use these cosmic events as a diving board for reflection and change.

Together with the change in seasons, we are in transition. Our bodies and minds are recalibrating. The cool dark fall nights are upon us. It’s time to get sassy and creative.

This week, for no reason at all, based on nothing, I thought I would discover the job of my dreams. One that would tap into my intellectual and creative skills, pay well and be spiritually satisfying, while allowing me to travel the world. That did not happen…yet.

At least I’m not feeling stuck. I am optimistic that I will be discovered. It’s not like I want to be a model or an astronaut – I’m being realistic, not grandiose.

Thinking we’re too old to make changes is what gets us stuck. I hear the too old excuse every day. But being older we have opportunities we didn’t have before. As a doctor with 25 years experience I’ve seen just about every complication at least once. We are wiser, we know the pitfalls. We know what we want. We also know our past does not define us.

Allow the power of the full moon to move you as it moves oceans. And don’t be afraid.

Intercontinental Parenting

My three children are adults now. They live in Australia, Los Angeles and Israel. I can’t picture any of them living in Milwaukee. They are happy where they are.

Here are some of the ways I deal with the distance. It’s not easy.

1.Trust their choices. My eldest daughter moving to Australia was tough. Australia is far – from practically everywhere – but it is where she found love. Israel is more than an abstract dream; for my youngest, it is home. My son ditched neuroscience and a medical technology company in Copenhagen to write, record and produce music in Los Angeles .

2. Blame yourself, a little. You showed them the world. You traveled as a family and never saw geography as an obstacle. As parents you fostered the confidence and independence they need to be away.

3. Visit them. Face the fact that in order to see your kids you may have to sit in a crowded metal cylinder in the sky for a full day traveling to places that you wouldn’t choose for yourself – LA that would be you.
Meeting half-way changes it up. Japan was a perfect halfway meeting point for our Australian and Hawaii a perfect place for her wedding. Europe works for our Israeli.

4. Make them come visit you even if you have to pay their way.

5. Create an active group chat. For us pictures of food and dogs dominate, with some great memes.

6. Coordinate reading the same book or watching the same series.

7. Once in a while send a card. It may take forever to get there but they will have something tangible to hold. Conversely get them gifts in their local shops and they can be delivered to their door.

8. Count your blessings if far away for you is driving distance.

9. Stay involved in each other’s daily lives. Your kids never stop needing you. Make sure they know you are there for them for everything. Don’t be restrained by time differences.

10. Never end a conversation before saying “love you”.

Sugar, sugar

Ask Dr. Annie K:

Why do I always crave something sweet after a big meal? Even if I ate enough and I feel full it seems like there’s room for a little dessert. Is there a medical explanation for this?

“Would you like to take a look at the dessert menu?”

Someone invariably in the group says yes.

It all goes back to the primal connection between our brain and our gut – why we refer to the gut as the “Second Brain”.

We could blame it all on ghrelin . Ghrelin is known as the “hunger hormone” which is produced in the gastrointestinal tract and brain. It stimulates the appetite and signals the brain to eat. New studies show that it can keep you eating, even when you are full. Consider the potential of this hormone to lead to a major medical breakthrough in weight management. It is one of many other factors that lead to overeating.

Sugar cravings happen for 3 primary reasons:

unstable sugar levels
emotional imbalance
habit

UNSTABLE SUGAR LEVELS

Eating food that is high in sugar and carbohydrates creates a quick, sharp rise in the level of sugar in your bloodstream. Insulin – a hormone secreted by the pancreas – kicks in to control blood sugar levels. As a result, blood sugar levels drop. Then the cravings start and that tiramisu is looking better and better. The sugar/insulin rollercoaster is dangerous. Besides the damage it does to our bodies, it wrecks havoc on mood and energy levels.

EMOTIONAL EATING

Any type of unbalanced emotional state can lead to sugar craving. Stress, anxiety, anger, and sadness can trigger a need of food, for comfort. Sugary desserts produce a serotonin and dopamine rush, neurotransmitters associated with mood-elevation. Feeling unusually happy can also incite cravings. A seriously great mood makes me want to celebrate with my favorite, marshmallows ;).

HABIT

Habit is a big one. If you grew up in a house where every meal ended in dessert, you may have simply developed the habit. Dessert follows dinner, no questions asked. It may be part of a tradition in your culture. This habit is now programmed in your mind.

A habit is still a choice and that choice is yours to make.

WHAT TO DO

The dangers associated with excessive sugar intact are documented facts. Sugar has been well studied. This is not one of those findings you can rationalize by saying “one day they say eggs are good for you, the next day they are bad”. FACT: High sugar is associated with obesity, tooth decay, accelerated aging of the skin, impaired cognition in children, diabetes, cancer, heart disease, depression and dementia. Type II diabetes is an epidemic in the western world.

I am not advocating cutting out all dessert. Stressing out over dessert is also unhealthy. If you need a little something sweet keep it little. A tiny dessert will relieve the craving with way less harm than the big dessert.

Stopping Antidepressants

Fran, a 36-year-old teacher, initially presented with symptoms of major depression with anxiety. She responded well to an antidepressant and I saw her twice a year for medication management. Nine years later, we discussed stopping the medication. I gave my usual spiel, recommending a one month long taper period.
Fran called a few weeks later on the emergency number. She was sobbing – feeling terrified and anxious. She was nauseated and fuzzy. Her body felt sick, like electrical shocks were zapping her brain and limbs. She was terrified she might have MS.

These were symptoms of withdrawal. We devised an immediate plan for a slower taper. By the end, she was taking small thumbnail “chips” of the pill. It took months until she was comfortable without the medication.

While some can stop antidepressants no problem or with minimal discomfort, more than half of the patients experience withdrawal effects similar to Fran’s.

Psychiatrists knew antidepressants could not be stopped “cold turkey”. We just didn’t know how to stop them. If patients were really miserable, we simply restarted the medication, misinterpreting symptoms as a sign of relapse. Patients hated it so much they wanted the medication back, thinking this was a sign of true need. Discontinuation horror stories are all over the Internet.

Guidelines state that withdrawal reactions are self-limited and last one to two weeks. Simply untrue. Recent studies show that withdrawal reactions can be longer and more severe than initially thought. Restarting medications has lead to a dramatic increase in the length of time patients are on these drugs. How much do we know about long-term risks?

This is not unique to antidepressants. How many of you have tried to stop proton-pump inhibitors (PPIs) for acid reflux? After a few days of heartburn you reach desperately for that omeprazole without giving the body time to adjust. Furthermore, long term use of both PPIs and antidepressants are associated with neurologic diseases like dementia.

Finally doctors are paying attention. There has been a new focus on withdrawal from antidepressants which will hopefully be generalized to other drugs. Research is surfacing about how to manage a safe discontinuation.

When I prescribe antidepressants we discuss withdrawal risks from the beginning. The taper must be super slow – it can take months or years. Dr. Mark Horowitz at University College London says many people “have to pull apart their capsules and reduce the dosage bead by bead”.

I was involved in the first clinical trials for SSRIs. Those were exciting times! Finally we had safer and better tolerated weapons to beat depression. These medications have saved lives. Now we need to be just as skilled at de-prescribing as we are at prescribing them.

CELEBRATE INDEPENDENCE

On the 4th of July Milwaukee is like Pleasantville, USA. This becomes a place where people are “swell and perky.” American flags fly proudly. Kids decorate their bikes in festive red, white and blue. There is a parade with floats, clowns, animals and classic cars. You can win a stuffed animal at the carnival. Roasted sweet corn, snow cones and cotton candy are standard fare, along with plenty of beer.

I love a holiday with no religion.

Family travels in and the walls of our house expand to fit whoever can stand the chaos. My famous American flag cake is expected. I don’t formally invite friends; it’s an open annual event by now. The barbecue grill is fired up for hours. We skip the carnival and the parade and spend the day in the water.

When darkness sets in, we move to the deck, leaning on the railing in anticipation. Local fireworks are launched from a nearby park and we can see them from our backyard. The colors light up the night sky and reflect off the lake. The deep booms and short pops are magnified and echoed in the bowl of the lake. Only after our dog Marley lost her hearing in her later years could she finally relax during the show.

Who can resist the glory of fireworks? Those brilliant, loud, flashes of light mesmerize even the cynics. Scientists say we like them because they scare us. I say they are a part of our collective unconscious. They bring us back to a time we believed in magic. Even when experienced in a group, the experience is paradoxically internal and personal: fireworks stir up a sense of nostalgia, wonder, and possibility.

The Lifeguard

In honor of the end of summer, here is a little short story about summer love.

The Mediterranean sea is unusually rough. The waves vigorously clap the sand, sending a salty mist into the ocean breeze. The white sand, like sifted flour, surrenders to the harsh waves, and is enslaved by the powerful water. Sailboats in the distance struggle their way toward the horizon. Topless women casually soak up the sun’s rays. Conversations and reading are light, as the scenery takes precedence.

She never tires of watching him as he scans the crowded beach. His eyes alert as he concentrates, to discern any hint of danger amid the playful sounds resonating from the water. Her eyes follow his large footprints sinking in and molding the sand. She marvels at his bronzed muscular calves laboring under his broad, sculpted torso. How gracefully he strolls along the beach, for such a large mountain of a man.

Every few minutes, without a pattern, he breaks his intense focus on the surf and glances back at her. Aware of the stirring she provokes, he fights the distraction and his gaze returns to the water, back to his duty.

A quickening of her breath and a flash of warmth envelop her body each time their eyes meet. Images of previous meetings bring a rosy tinge to her cheeks. Her body is aching, alert, wanting. She lusts for the physical closeness, so different from the touch she is familiar with at home. She craves the full weight of his body on hers, allowing her to feel small and protected.

She is suddenly ashamed. Her actions and their unspoken implications flood her mind, trap her and suffocate her. A revolting taste of guilt fills her mouth and her body grows limp. A glance from him reins her in and she allows herself once again to feel and not to think. She chooses expansion over contraction, upheaval over order, and freedom over settling.

When the crowd thins out and darkness creeps in, she carefully climbs the steep steps to the lifeguard station, clutching her sarong tightly. It feels like a treehouse -secluded and private. It is their sacred space. When the beach is clear he joins her, carrying two small glasses of Arak. Their lovemaking is slow and deliberate. The air swells with the scent of sex, salt, sweat, anise, and desire.

Mercury Retrograde And What Does It Have To Do With You?

 

Mercury in retrograde – the default scapegoat when you’re having a bad day, your computer crashes or if you have to explain doing something really impulsive. Before we start judging it as fact or folly, L+M wants to know what it actually means. It suits me as a once aspiring astronaut who always wondered about astrology.

Mercury Retrograde. Take a deep breath. And don't text your ex.

Mercury is a tiny planet that moves super fast. When Mercury zips around the sun, as it passes Earth it appears to be moving backwards, from Earth’s vantage point. This optical illusion is what is known as Mercury retrograde. This happens about 3-4 times a year and lasts three weeks each time.

Stargazers have always been fascinated by retrograde motion. When Mercury speeds by, it creates a sort of disruption or turbulence that is thought to affect us on earth. In astrology, Mercury is associated with communication, relationships, travel, contracts, and computer codes.

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