Saturday, March 21, 2020

Responding to the Corona Virus - a More Hopeful Approach

closeup photo of yellow sunflowersThere is no doubt the corona virus "pandemic" is enveloping every avenue of our society...our world right now. Fear is rampant, anxious thoughts inundate the minds of many, questions arise about the uncertainty and panic covers our world as if blanketing it with an eerie presence. People keep asking me what I think about all of this; is it real or is this a hoax? More questions filter in about whether or not I am afraid of contracting it or if I feel comfortable going to the grocery store. Clients ask me if I am still holding appointments in my office. Others question how to deal with the spirit of fear that is everywhere and how to effectively deal with the social isolation that is being mandated across the globe.

I could delve deeper into detail in terms of what I believe to be true in the midst of this - the research, the numbers, the facts - but I will leave that to another day. My point in this post is different than the usual content of this blog because it is not a referenced article. However, I believe it is of key importance in the midst of this unprecedented circumstance. This idea was prompted following a conversation with my sister earlier this week. As we were discussing all that is unfolding, my sister said "I am hopeful that something good is going to come out of this...something surprisingly good". That struck me and I began to craft what that belief might look like in practical terms.

The approach I have determined to take is one that bucks the current paradigm. "I choose hope" has become my mantra in these trying days. It is a complete shift in mindset when compared to the overwhelming message of despair that is covering our world and I believe it is essential. How easy it is to get wrapped up in all that is wrong right now and if we are not intentionally focused on something else, we too will fall prey to the spreading of despair. I don't want to simply roll my eyes and say "this is crazy" (which I have been guilty of doing) but rather I want to combat this fearful mentality with actionable hope. So what does that look like in practical terms? I'd like to use this post to point out a few ways that we can all engage in, not only with a hopeful outlook but also practical ways to implement hopeful actions.

Actionable Step #1 - Fill your mind with goodness. It likely comes as no surprise that when we fill our minds with negativity, we begin to act in a like manner. So in other words, negative input produces negative output. Intentionally seek to fill the atmosphere of your mind with uplifting content. For me, that looks like reading my Bible daily, reading articles that reflect hope, listening to news that does not solely focus on despair and negativity but rather hope in the midst of chaos, listening to uplifting music.

Actionable Step #2 - Creating a "hope list". This is a list of intentionality - choosing to be hopeful in the midst of chaos and negativity. The content focuses on ways to be intentional about embracing these days and weeks and months and making them joyful, deliberately fulfilling, productive and memorable.

Actionable Step #3 - Looking for every opportunity to combat the spirit of fear. I won't sit in my house, secluded from society, fearful of being in someone else's presence. I will be respectful of the views of others and will not attempt to force my beliefs on anyone but I will not isolate myself. I will go to the grocery store, I will take walks in my neighborhood, I will welcome clients into my office, I will even shake someone's hand if they extend theirs to mine.

Actionable Step #4 - Being wise in everyday practices. Be mindful of those who are at great risk and steer clear (nursing home residents, frail or sickly individuals, tiny babies). Don't plan a giant party. I will not be foolhardy but I will be mindful of health-related practices. I will be a bad host for illness by washing my hands after being in public, eating food that follows a pattern of dietary excellence, drinking plenty of water and exercising daily. In short, I will continue caring for my body the way I always do.

Actionable Step #5 - Willingly accepting that I am not in control of these circumstances. I do not have the ability to change any of this. Therefore, I choose to leave the outcome up to God, thankful I have not been tasked with being in control!

Not so difficult really. You might notice a theme interlaced throughout each actionable step - intentionality. These things may not come naturally to you...which is actually the point. These items are not complicated and yet they will remain undone if we do not deliberately embrace them. What impact would be made if more people followed these steps as opposed to actions that perpetuate fear and anxiety?

I would encourage you to set this as your purpose in this season:
Intentionally embrace hope by filling your mind with goodness and deliberately focus on actionable steps which reflect that mindset.

Monday, March 9, 2020

Interstitial Cystitis Conclusion

As this review has demonstrated, IC is a life-altering disease riddled with multiple uncomfortable and disruptive physical symptoms. Oftentimes the disease goes undiagnosed or misdiagnosed and is oftentimes referred to as a diagnosis of exclusion. The rate of comorbidity is elevated in those suffering from IC, displaying the additionally challenging issues that accompany the management of multiple disorders. Equally distressing is the elusive nature of causality for IC, leaving patients with a sense of helplessness, in addition to the inability of doctors to confidently recommend preventative measures. Though multiple diagnostic tests are performed, none have been specifically created for the diagnosis of IC. Some are invasive or uncomfortable and oftentimes the diagnosis is a result of simply eliminating a whole host of other diagnostic possibilities before arriving at the IC determination. This process can be frustrating, lengthy and defeating to the patients who have been suffering for long periods of time. Of even great importance is the questionable validity of treatment modalities. As has been observed above, pharmacological treatment is oftentimes ineffective or perhaps mildly effective but carries with it the significant risk of adverse side effects. More complementary and alternative methods (CAM) such as yoga, physical therapy, acupuncture, probiotics, dietary interventions and psychological strategies have shown benefit in a number of studies. However, oftentimes sample sizes are small and the amount of credible and substantial evidence is lacking, thus calling into question the advisability of assuming any one of these techniques provides the curative key to IC. The overarching benefit to CAM is the absence of notable risks and adverse side effect profiles. Perhaps the bottom line in light of this review is to focus on the issues that can be improved or solved and let further research determine the direction for the unanswered questions at hand. Using a variety of CAM techniques provides the potential for benefit and should perhaps be considered first-line treatment, while steering clear of the riskier pharmacological methods.  Though this appears to be a logical approach to a difficult problem, the unfortunate reality is that oftentimes logic is lacking in the overall outlook on health. As always, lots of work to be done.

Monday, March 2, 2020

Interstitial Cystitis Part VI

Treatment Modalities: Psychological Strategies
Though perhaps not widely understood or considered, psychological strategies and techniques can offer potential benefits to those suffering from pain disorders by aiding patients in the development of better coping strategies and transforming underlying pain beliefs.49
In a study of 138 participants with an IC diagnosis, patients were surveyed to determine the use and effectiveness of psychological self-care strategies in the management of symptoms.50 Following review of results, researchers concluded that women suffering from IC engaged in a number of psychological self-care such as downward comparison, self-validation, empowerment, information-seeking, connection with others and taking personal responsibility for illness.50 Results demonstrated improved ability to cope depended upon the use of  information-seeking, downward comparison, empowerment, connection with others and self-validation.50 Of most significance, researchers stated that involvement in a support group was perhaps the most important strategy employed.50
A study of 108 subjects with pain-related distress and disability participated in several acceptance-based strategies to determine effectiveness in dealing with pain.51 Treatment tools centered around increasing patient willingness to deal with uncomfortable thoughts and feelings and instead focusing attention on behaviors that encourage improved functioning in the long term rather than caving to a momentary feeling.51 In addition, physical exercise, health habits and meaningful life directions were addressed as components of therapy.51 Researchers concluded that the pain and functional ability of the patients improved significantly at post-treatment and at three month follow-up when compared to pre-treatment.51 More specifically, improvements across participants included 41.2% improvement in depression, 25% improvement in physical disability, 39.9% improvement in psychosocial disability, 61.8% reduction in hours needed to rest as a result of pain during daytime hours, and 48.2% improvement in the ability to repeatedly perform sit-to-stand endeavors.51  Researchers stated that psychological methods for dealing with chronic pain have significant evidence to support their effectiveness yet confirmation of  particular treatment modalities that lead to improvement are lacking.51 Further, researchers stated that an acceptance-based treatment approach challenges the pain experience overall and offers a very promising avenue for further development in the management of pain.51

49. Atchley MD, Shah NM, Whitmore KE. Complementary and alternative medical therapies for interstitial cystitis: an update from the United States. Translational Andrology and Urology. 2015; 4(6): 662-667. 
50. Webster DC, Brennan T. Use and effectiveness of psychological self-care strategies for interstitial cystitis. Healthcare for Women International. 1995; 16(5): 463-75.
51. McCrackena LM, Vowlesb KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy. 2005; 43: 1335–1346.