NurseKeith's Corner

When you have experienced a shock or major life event such as a death, loss or other trauma, it is a time for great gentleness with yourself and your loved ones, and a time to forego any decision-making until the trauma and its effects have passed.

In a heightened emotional state caused by loss, grief or trauma, it is easy to allow one's emotions to run amok. When under siege by strong emotions, it is never advisable to make major decisions about relationships, money, employment, or other significant aspects of life until one's life has regained some semblance of normalcy.

Emotional trauma and difficult life passages are times of great significance, but also times that call for restraint. If you have experienced a major stressor or life event, be certain to refrain from making decisions under duress until the dust has settled and you can calmly make decisions that are in the best interest of all concerned. Whether it be decisions about relationships, finances, employment, career, or other areas of interest and concern, it is paramount that you recognize your emotional fragility at such times, and avoid making premature decisions that may have long-lasting and significant effects long after the memories of current events have faded.

Making significant decisions about one's life is important, but the timing of such decision-making is equally so. If you are under the influence of an event that has rocked your world in any way, take a breath and let time pass. You will be grateful for your restraint.

If someone you love chooses to end their life and completes a suicide attempt, the aftermath of such a tragic and sudden loss can be devastating.

Whenever someone we care about dies, it is natural to experience feelings of guilt, to consider whether one could have given more, done more, or otherwise been more present for that individual. When someone kills themselves, the feelings of guilt and self-recrimination can become even more pronounced, and one begins to question whether one could have actually prevented or foreseen such a final and desperate act.

For some, suicide is the ultimate selfiishness, an example of how someone can take an irrevocable step into the void, leaving their loved ones behind in a rash act of self-inflicted violence. For others, suicide is simply a choice determined by the individual and no one else, a choice to which everyone has a right as a self-determined being.

No matter the philosophical reasoning, coping with the suicide of a loved one is a complex and difficult life passage, and professional help is often essential in order to guide survivors through an emotional mine-field.

If someone you know takes their own life, it is essential that you practice the greatest level of self care possible. Keep hydrated, eat well, avoid the overuse of alcohol, try to keep to a regular sleep schedule, and self-monitor for feelings of guilt and excessive grief. There are many mental health professionals who specialize in grief and loss, and it is paramount that you seek out professional help if you are having difficulty with basic self-care and daily functioning,

There are many tools available when one is coping with sudden loss, and one need only reach out and make use of those tools when the need arises. Friends, family, mental health professionals, medical providers, clergy, teachers----these are all potential balms for a mind weighed down by grief, loss, sorrow, or guilt. If short-term anti-depressant or anti-anxiety medication is needed, avail yourself of those options if appropriate, but only under the guidance of a medical provider or physician.

Suicide and sudden death are both common and shocking experiences. Losing a loved one to violence or suicide is not easy, and the torn fabric of one's life can be difficult to mend.  If you or a loved one suffer this form of loss, be sure to practice the best self-care possible, seek professional help when appropriate, and know that time is indeed itself an excellent healer.

Beta-carotene is part of a group of substances called carotenoids that are responsible for the orange color of many fruits and vegetables. Once ingested into your body, beta-carotene is converted to Vitamin A, which serves as an antioxidant along with vitamins E and C. Beta-carotene can be found in orange, yellow, red and dark green vegetables, including pumpkin, squash, carrots, sweet potatos, kale, broccoli, mango, turnip greens, canteloupe, spinach and apricots.

Beta-carotene's antioxidant properties are useful in the prevention of cancer, the prevention of macular degeneration, the boosting of the immune system, strengthening of bones, improvement of vision, and the protection of the skin against sunburn. There is also some evidence that beta-carotene is helpful for depression, Parkinson's Disease, psoriasis, arthritis, high blood pressure, and asthma.

In extreme cases, overuse of beta-carotene can cause yellowing of the skin and and diarrhea, however these side effects are not long-term and can be easily reversed by reducing intake.

Although Vitamin A can be taken as a dietary supplement, there is no substitute for regular daily intake of orange, yellow, red and dark green leafy vegetables for prevention of cancer and overall health. 

If you suffer from migraines, there are most certainly foods and other substances which may indeed trigger your headaches, or at least cause them to be worse than they might be. While every person is different, some common migraine triggers include:

• Emotional stress
• Menstrual periods
• Changes in your sleep patterns
• High levels of caffeine
• Caffeine withdrawal
• Fatigue
• Weather conditions (like changes in barometric pressure)
• Smoking
• Exercise
• Bright lights or flickering lights (like flourescent lighting)
• Specific odors or foods

In terms of foods, there are many potential migraine triggers, including:

• MSG (monosodium glutamate, a common additive in Chinese food)
• Alcohol
• Aged cheeses (like blue cheese and feta cheese)
• Luncheon meats, hot dogs, and other processed foods which may contain nitrates and nitrites
• Smoked and dried fish
  

Each individual with migraines is different, and every person must determine their particular triggers over time. Keeping a headache diary is one very good way to assess the patterns related to your headaches. If you decide to keep a diary, be sure to record the time of day of each meal, the specific foods eaten, the activity you were engaged in prior to the migraine, the amount of sleep you had the night before, and any specific stressors in your life at that time. Although this may seem like a cumbersome undertaking, several months of keeping a headache diary may very well reveal some important---and potentially life-changing---information that could indeed assist you in significantly decreasing the frequency and severity of your headaches over time.

As always, if you have questions about your migraine patterns, triggers or treatment, consult your medical provider.

Since I just witnessed a roofer fall off of the roof of my cousin's house, I wanted to share my experience on Black Doctor regarding reacting and responding to events involving falls.

When a person experiences a fall and you have even the slightest suspicion that they have injured their neck or spine, it is of the utmost importance that the person not be moved until paramedics or EMTs arrive on the scene. The vertebrae and nerves along the spine are quite delicate in the cervical (neck) area, and moving a injured individual in order to increase their short-term comfort could actually have a long-term negative impact on their well-being.

Falls can be extremely traumatic, and I will use the roofer's fall as an example. When I witnessed the roofer falling from the roof off of his ladder, I knew by the sound that he had struck the lower roof and perhaps the stairs and deck below. Multiple injuries were possible, and there were only so many things that we could do prior to professional help arriving.

First, we determined that the victim was conscious and breathing. Simultaneously, we called 911 and described the accident and the victim to the dispatcher. Meanwhile, I asked the poor gentleman to tell me his name, his address, and the date and the day of the week in order to determine his level of consciousness. While speaking with him, I assessed for obvious signs of bleeding, determined that his pupils were not significantly dilated, and that his breathing was regular.

Although the young man was potentially seriously injured and extremely uncomfortable, I explained to him that he could not move, that I could not help him pull his arm out from under his body, and that we would simply stabilize him and make him as comfortable as we could. We placed a pillow under his head without making him move his neck, placed a pillow under his knee to support his leg, kept him talking and engaged with us in conversation, and covered him with four blankets in order to stave off shock and the effects of the cold autumn air.

Spinal injuries from significant falls can be very dangerous, and it is imperative that witnesses and bystanders not move a potentially injured individual unless there is absolutely no possibility of professional help being located (like in extreme wilderness situations). The most important thing is to remain calm, reassure the victim, make the victim comfortable without moving him or her, and call the local emergency services number as quickly as possible.

Make sure you know how to respond to these sorts of emergencies, and review it with children, babysitters, caregivers, and other family members. Never move a person with a potential spinal injury, and let the medical professionals care for the injured as soon as possible. Falls do happen, and reacting responsibly and correctly is paramount.

Mothballs have been used for decades as a means to prevent moths and other insects from destroying clothes, linens, and other household goods. However, mothballs pose a serious health risk and should be avoided by anyone concerned for their health or the health of their family.

The chemical that gives mothballs their distinctive scent is paradichlorobenzene, a compound that is known to cause neurologically-based headaches. However, napthalene is the main ingredient of the modern mothball, and this chemical can be severely toxic to pets, children, those with respiratory diseases, the elderly, as well as developing fetuses. While mothballs are indeed solid, the fumes that they release in the form of a gas provide the perfect medium through which to negatively impact the human body.

The main threat to individuals exposed to mothball fumes is from direct exposure to the napthalene gas released by the mothballs or by coming into contact with clothes that have not been properly aired after storage. If you have clothing stored with mothballs, be sure to air them outside for at least 24 hours before attempting to use them.

Small children have also been known to eat mothballs, a dangerous for of poisoning which must receive immediate treatment. If your child eats mothballs or other toxic substances, call the National Poison Control Center at 1-800-222-1222.

A less toxic yet more expensive alternative to the use of mothball is cedar blocks, shavings or oil. While the blocks are indeed expensive, cedar shavings in the form of hamster bedding can be very inexpensive. Cedar-lined chests and closets are also very effective.

While mothballs may indeed be commonly used, many individuals who are exposed to them---especially children---may experience negative health effects from the benzene-based chemicals described above. There are alternatives to mothballs, and while they may be more expensive, unnecessary exposure to dangerous chemicals is certainly something to avoid in the interest of your health, well-being and longevity.

With Autumn fully with us and Winter not far behind, it's a good time to consider what changes you could make to your daily routine. Changes of season are perfect opportunities to reevaluate and reassess how you go about caring for yourself physically, mentally and spiritually, and why not take a moment to pause and reflect on what might be ready for as adjustment?

Exercise: is your summer exercise routine difficult to continue once the weather turns cold? Do you usually run or swim outdoors but the cold weather then becomes an impediment to continuing? What do you need to do in order to develop a wintertime exercise regimen? Do you need to do yoga at home, join a gym, or get on that stationary bike that's gathering dust in the basement?

Nutrition: with the holidays in mind, know that over-eating and indulging in sweets and alcohol may put you at risk of weight gain or complications with your health if you're diabetic or otherwise living with a chronic illness. What changes can you make now before the holiday season kicks in? What dietary habits might need to be changed? How can you clean up your diet before the season begins, giving you a head-start and preventing unnecessary weight gain and nutritional challenges?

Mental: are any mental habits to which you are accustomed needing revamping or fine-tuning? Are you focused on lack, worries and anxieties? What can you let go of now to lighten your load?

Spiritual: do you have a meditation practice? Do you pray on regular basis? Have these practices fallen by the wayside? Perhaps now is the time to bring those habits back into the present day for the benefit of your overall health.

It's Autumn, the holidays are coming, and we all can pause, take a breath, and decide what fine-tuning we can do for many aspects of our health. Take a moment, assess these different aspects of your health, and perhaps there are several small and incremental changes which you can make that will provide long-lasting benefits far beyond the Autumn and Winter seasons.

A very simple way to decrease stress and practice basic self care is to take a daily walk.

Decades ago, people would take what was then called a daily "constitutional", a walk for health and well-being. In certain European countries, you will find entire families walking around town in the evening after dinner, taking in the night air, chatting, and catching up with friends and neighbors who happen by.

These days, many Americans can go weeks without intentionally taking a walk. We may walk from the house to the car, from the car to the store, and perhaps stroll around the mall while we shop, but rarely do we make a clear decision to take a walk for walking's sake.

Walking can clear the head, help one mull over problems, and provide a few quiet moments for us to relax on our own or with a loved one or friend.

For those of us with cardiac, musculoskeletal, respiratory or circulatory conditions, gentle daily walks increase circulation and oxygenation, provide exercise for the major leg muscles, and weight-bearing exercise is excellent for bone health and calcium absorption.

Daily walks provide many health benefits for those with any chronic health condition, and whether these walks are gentle "constitutionals" around the block or a power walk around the high school track, walking is an excellent way to improve one's physical and mental health in an easy and user-friendly way.

If you are an individual with respiratory disease, consider doing an environmental survey in order to assess your home for substances which may exacerbate your respiratory symptoms. Many common household products contain acetone, formaldehyde and other substances and chemicals which may have a direct impact on many aspects of your health, especially your respiratory status.

When considering your home, assess the cleaning products that you use. Ammonia-based products, air fresheners, solvents, bathroom cleaners, fabric softener sheets, and other common products can cause asthmatic symptoms and wheezing.

In terms of fragrances, consider that most scented candles contain chemicals and unidentified ingredients that can also worsen asthma and respiratory disease. Febreze and other air fresheners can also be culprits.

Also, consider that common air fresheners hung from the rear-view mirrors of many cars can also be problematic for many people, even those without respiratory conditions. (Bear in mind that the chemicals in such fragranced products can also cause neurological symptoms such as headaches, confusion and irritability.)

Remember that the products you use on your body (deodorant, shampoo, perfumes) and the products you use in your home can directly impact your health, and if you live with a chronic respiratory condition, consider how some of the products in your home may be impacting your health in ways of which you are unaware. Try doing an environmental scan of your home, and see what may be effecting you, your health, and the health of your family.

Americans work hard, and while those of us who are lucky enough to have paid vacation usually receive perhaps two or three weeks per year, our European counterparts receive anywhere from six to ten weeks of vacation every year! While relaxation and leisure are indeed valued here in the States, American companies and businesses are not terribly generous when it comes to time off for employees. Many of us have probably known pregnant colleagues who have given birth and only been able to stay home with their newborn baby for eight weeks before returning to the office. This is unheard of in Europe, and it’s no wonder that stress-related illness impacts Americans in such a ubiquitous manner.

So, perhaps you’re feeling the effects of stress. You may even be experiencing burnout on the job. And when you look at how much vacation time you’ve accrued, you’re hesitant to take any time off since you’re saving up your earned time for a summer vacation with the family. You find yourself caught up in the very real dilemma of figuring out what to do when you need time off but just can’t afford to take it.

Sadly, this is a position in which more and more workers find themselves, and when we are unable to take time off, we have to become creative with how we care for ourselves. If you are unable to take time off from work, what are the ways in which you can care for yourself when you are not at work? What are the things that you like to do? What hobbies or interests pique your curiosity? How do you like to spend your time when you aren’t working? Here are some suggestions:

If you have a partner or spouse, can you ask for one free evening per week when you can do whatever you want?

Is there a hobby that interests you? Is there a class that you can take to support that interest?

How can you make your evenings and weekends more like mini-vacations? Can you turn off the phone? Lock the door? Make a special meal? Take a sunset walk with your spouse every evening? Ask a friend to watch the kids so you can ride your bike every Saturday afternoon or go for a swim? Enroll in a meditation course? Listen to your favorite music?

Stress can come home to roost for even the most efficient and thoughtful person, and when time off is at a premium, we often have to pay extra attention to the ways in which we care for ourselves when we aren’t working. When you have two weeks of vacation every year, taking a day off to do nothing but sleep may seem like a luxury that you simply can’t afford, so building in time to care for yourself in other ways is paramount. All work and no play certainly makes us dull, but it can also make us sick. Finding ways to have fun, relax, and experience leisure is a part of overall health that simply cannot be ignored.

If you are a coffee drinker, there are a few things you should consider when it comes to your health. Coffee has been in widespread use for centuries, but every person who makes coffee a part of their daily intake would be wise to consider the risks and benefits therein.

Of course, we are aware that caffeine is a drug which can raise your heart rate and blood pressure, and this should be a concern for anyone with a cardiac condition. This increase in blood pressure can also be problematic for people with glaucoma due to increased pressure in the eye.

For diabetics and those with renal diseases, there are some who feel that coffee can lead to dehydration by acting as a diuretic, although this is an argument that has not yet been resolved. Some believe that coffee simply adds to fluid intake like any other beverage, with the caveat that the increased urination caused by coffee in some individuals might cause a net loss of body fluid.

Coffee has been shown to have some antioxidant properties, potentially being protective against certain types of cancers. There is some evidence that coffee can also reduce the incidence of certain liver diseases and dental caries, although opinions do vary in this regard as well.

As for other potentially negative effects, sleeplessness, anxiety, and gastrointestinal problems have been widely reported by those who drink large amounts of coffee, and there is some evidence that heavy coffee consumption during pregnancy can potentially have an impact on the likelihood of stillbirth. As for decaf coffee, many solvents are used in the decaffeination process which may also pose a risk to mother and child.

Looking at iron absorption, some evidence does exist stating that coffee can lead to iron deficiency anemia in some coffee drinkers, especially in mothers and their breastfeeding infants.

As you can see, there are widely varied opinions on the health benefits and risks of coffee consumption. When it comes to drinking coffee, most doctors and health professionals will readily agree that moderation is the most important way to assure that any negative effects are mitigated.

Coffee has been consumed for centuries by people the world over, however we must remember that modern humanity has radically changed the calculation by using coffee as a means to be more productive and attentive in a world that demands a pace of productivity never before witnessed by previous civilizations. Also, in modern times, coffee production has become extremely industrialized in terms of the use of chemicals, pesticides and herbicides, as well as the aforementioned solvents used to decaffeinate coffee for consumers who wish to decrease their caffeine intake. The coffee that we now drink by the gallon is considerably different than what our grandparents used to brew in their percolators. 

As always, whether we are discussing coffee, medications, herbal remedies or exercise, talk about your concerns and questions with your medical provider, err on the side of moderation, and listen to your body when it comes to knowing how much is enough, and whether coffee is the right beverage for you.

Now that it's autumn, if you live in a place where the colorful leaves are changing and falling to the ground, you may be acutely aware that winter is on the way. With autumn comes the inner and outer preparation for winter, and depending where you live, winter preparations can range from nonchalant (preparing for some rain and clouds in some areas) to very intense (stacking firewood and readying for snow, ice, and bitter cold). 

Whatever type of winter you're preparing for, our bodies also need preparation, and it's a known fact that our metabolism can change significantly as the weather turns colder. While in summer you may find that you crave fruit, light foods, smoothies and salads, sometimes it seems like a switch gets flicked in November, and all of sudden you crave nothing but heavy carbohydrates, potatoes, bread, pasta and baked goods---and the holidays are no help in this regard! You see, our bodies know that winter is coming and they naturally want us to pack on the pounds so that we can store energy for the coming winter (in the form of extra body fat). Our bodies expect the winter and are wired to prepare for famine by biologically urging us to gorge, so these are the days when close attention to our diets can really pay off in the long run.

Now, as a nurse and health and wellness coach, I am not one to counsel my clients to simply eschew breads and pastas and sweets completely. There is, of course, a natural tendency to crave the denser foods when the weather turns cold. However, there is a time and place for everything, and being mindful of our intake is the key to maintaining our weight, even amidst winter and the onslaught of the holiday season and its parties, gatherings and feasts. 

If you are diabetic or have heart disease, you already know that simply filling up on empty carbs is not in your best interest no matter the time of year. You have to be mindful, think carefully, plan your meals, and make up for your dietary excesses if you happen to go a little wild at Aunt Bessie's Thanksgiving dinner. Finding balance---even when the holidays are here---is a challenge, but maintaining weight and fitness throughout that process is entirely within your power. 

So, if you are going to have a sugary treat, make sure to balance it with some lean protein, since protein will slow the release of those simple carbs into your bloodstream. Having a piece of delicious coffee cake? Couple it with yogurt or cottage cheese. Also, have a smaller slice than your mind wants, appeasing your craving without going whole hog. And if you happen to go carb-heavy at one meal, make the next meal a light one, choosing salad with grilled chicken rather than a sandwich or pasta or potatoes. These small decisions go a long way towards tempering your appetite, allowing you to "cheat" a little, and keeping your diet balanced even as you enjoy the fruits of the season. 

Controlling weight and cravings can be challenging, especially in the winter. But with mindful eating and good choices, we can maintain a steady weight---or even lose a few pounds in the process---if we are conscious of what we eat, the portions we choose, and the types of food we put in our mouths.

I will be posting more about diet and nutrition in the coming months as we head towards the holiday season, so please be sure to tune in for further installments! 

Dear Readers,

Due to personal circumstances, this blog will be on hiatus for the month of September. Have a wonderful month, and I will be back with more blog posts in October!

Best,

Keith

Following up on my recent post about H1N1 influenza, please be aware that the media can often cause the general public more alarm than is actually necessary. While H1N1 is indeed a real threat and many people could potentially become sick or die as a result, there is still a high degree of uncertainty as to just how virulent it will turn out to be as the flu season kicks into gear.

Misinformation and media exaggerations can often create panic in times when a vigilant calm would be most helpful. If you are confused about H1N1, or have questions about the flu, vaccines, or whether or not you or your family are at risk of illness, it is highly recommended that you discuss your concerns with your personal physician, or call your state or local public health department for more information. Many states have created staffed information lines that the general public can call, and the website of the Centers for Disease Control and Prevention (http://www.cdc.gov/h1n1flu/) is still one of the best resources on the web for up to date information.

Remember that H1N1 is a real threat, but the extent of that threat has not yet been established. If you wash your hands frequently, avoid spending time with people exhibiting symptoms of influenza, obtain a flu vaccine, and consider receiving an H1N1 vaccine if you meet the criteria for doing so, you are indeed taking many steps towards maintaining your health and safety.

Please stay tuned for more updates, watch the CDC's website for new information, speak with your local or state health department, and trust yourself to make healthy decisions for you and your family as the flu season begins in earnest.

In my current position as a Public Health Nurse, H1N1 (formerly known as Swine Flu) is looming large as the regular flu season approaches. Here are some points to keep in mind as children go back to school and cold and flu season begins.

Handwashing still remains the best way to prevent the spread of disease and protect yourself against infection. Even though it sounds like an old wives' tale, doorknobs, banisters, fauctes, toilets, money, computer keyboards and other "high touch" objects do indeed carry droplets left by other people, and you can easily pick up viruses and bacteria from contaminated surfaces.

Seasonal influenza kills approximately 35,000 Americans each year, the majority being over 65 or those with chronic illness. A flu vaccine is still one of the safest ways to prevent the flu, or at least keep it from being quite as nasty an infection. Flu vaccine should be available nationwide beginning late August, and you can receive an injection through next June and still receive some protection. However, the earlier you receive a vaccine, the better, of course.

The H1N1 vaccine is now in clinical trials and will most likely be widely available through public clinics, schools and private medical providers by the end of October. There will be a widespread public relations campaign related to the vaccine beginning in September. The safety of this new vaccine is still being tested, and it is expected that a series of two shots one month apart will ne necessary to provide complete immunity.

As children go back to school, monitor them for signs of illness and fever, If your child has a fever, they cannot return to school until 24 hours after the fever has ended, not including the use of Tylenol to lower the temperature. If you have questions as to whether your child should remain home, please consult school officials, or check the websites of the Centers for Disease Control, your state Department of Public Health, or your local health department.

Please stay tuned to this blog for further updates and recommendations regarding seasonal influenza and H1N1 influenza, and remember to wash your hands!

In these days of economic duress and difficulty, it can sometimes be difficult to remember to be grateful for what we have. I have written several times about fostering an "attitude of gratitude", and I share these thoughts because they carry personal resonance for me in my own struggles and challenges.

One practice that I have found most helpful is using a simple meditative technique to foster gratitude and remind myself to focus on my blessings. Similar to the use of a "mantra" or repetitive phrase to focus the mind, this technique allows the mind to narrow its "gaze", so to speak, and filter out other thoughts that tend to intrude and distract one from concentrating.

The practice involves sitting in a comfortable position, with eyes open or closed, breathing in and out at a very relaxed and natural pace. On inhalation, you focus on the words "I am so blessed", making the phrase last as long as the inhaled breath. On exhalation, one focuses on the phrase, "I am so grateful". It's as simple as that.

As basic as this exercise may appear, you may find that even after four or five breaths, your mind will wander and you will have completely forgotten to repeat the phrases, "I am so blessed" and "I am so grateful". At this point, there is no need for self-recrimination or blame. Simply refocus your mind, begin breathing again, and continue the process. In any one sitting, if I can manage 20 in-breaths and 20 out-breaths with no distraction, I feel that I have truly accomplished something considerable.

Practicing an attitude of gratitude may be difficult when life is tough, but it is truly the tough times when gratitude and the remembering of one's many blessings can have the most positive impact on one's life and mental health. This simple meditative technique (one might even call it "prayerful"), offers a few simple moments of reflection and gratitude amidst the tumult of the daily grind.

Five full breaths and a few moments of gratitude felt deep within one's being can radically alter the course of even the most difficult day. I offer this technique because I strive to use it myself in my daily life, and perhaps you, dear Reader, will find it a benefit in yours.

In recent years, many of us have heard the term "Life Coach". Perhaps some of you know a friend or loved one who works with a life coach, or maybe you have even spent some time with one yourself. The coaching field is currently booming, and the newest form of coaching hitting the mainstream is health and wellness coaching.

Health and wellness coaches work with clients to set goals related to health, wellness, fitness, or disease management, and then assist and challenge the client to work consistently towards those goals in a systematic basis, using personal accountability as a method of keeping the client on track.

While there are several organizations which certify health coaches, there is no national standard as such, so it is up to each client to decide if a coach has the credentials and skills to deliver the advertised service. Many nurses---myself included---are pursuing training as health and wellness coaches, since nurses are, by default, trained to coach patients through the management of disease and the fostering of practices that facilitate wellness.

Thinking of the quintessential coach, we might think of a tough-as-nails middle-aged man in a baseball cap, barking out orders on the sidelines of a football field. While there may be some life coaches and health coaches who work in a confrontational style, the world of professional coaching has a much more urbane and sophisticated approach, and there are many books and philosophies which inform the work of coaches around the world.

There are times in life when we may need an extra push in order to accomplish the fulfillment of our goals when it comes to our health. It may be weight loss, exercise, the management of a chronic disease, or stress management, but many of us simply do not have the wherewithal to fully and objectively hold ourselves accountable for our actions and our commitments. A health and wellness coach can be the person who we assign the task of holding us accountable, and while this is a relationship that bears a financial cost, many of us are willing to invest money now in order to reap the benefits of health and wellness later in life.

For those who are lactose intolerant, vegan, allergic to soy, or simply don't like milk and milk products, oat milk is a very healthy alternative that brings with it many health benefits. While there are many alternative milk products on the market---soy milk, hemp milk, rice milk, almond milk---my newest love is organic oat milk.

Oats are easy to tolerate by the digestive system, high in fiber (including soluble fiber), moderately high in protein, cholesterol free, lactose free, and contain Vitamin E, folic acid, and other trace minerals and elements. Oats are rich in cancer-fighting phytochemicals, and may also help to prevent stroke and heart disease.

Oat milk is made from oak groats, which are basically the hulled grain broken up into smaller pieces. Many brands add calcium, riboflavin, B12 and other nutrients to increase the nutritional profile of the drink. In terms of brands, my favorite so far is Pacific Natural Foods' Organic Oat Milk (vanilla flavored). I like to use oat milk in smoothies, on cereal and as a cold beverage, although I have not tried adding it to hot tea or coffee.

These alternative milks sometimes curdle in hot drinks unless you heat or steam the milk separately. Also, please read nutritional labels carefully, since many companies add high fructose corn syrup and other sweeteners to these beverages. Look for the brands that use rice syrup, a much healthier form of natural sweetener. I will be profiling other alternative milk beverages on this blog from time to time, so please check back for other installments in the series.

For those health-conscious readers who would like to decrease their intake of animal products and animal proteins, there has never been a better time to seek out non-animal protein options for consumers. (Vegan is a term that defines a diet without animal products of any kind.) And remember, vegan proteins are ubiquitously heart-healthy!

When discussing vegan diets, the question of how to get enough protein is a frequent concern. But you don't have to be a vegan to partake in the dietary practices of vegans. While you may not eat Italian food every day, there are indeed times when you might choose to do so, and eating vegan is also simply a choice that one can make at any given time, and a vegan meal can be healthy, satisfying, delicious, and a nice change from your normal routine.

When it comes to vegan proteins, the most basic choice is beans and legumes. In many traditional indigenous cultures (in Latin America, for instance), the combination of rice and beans is an affordable and healthy combination. And if you choose to make brown rice with those beans, then the combination then becomes a complete protein.

Quinoa (keen-wah) is a grain that is quickly gaining wider acceptance among American consumers. While it may be slightly more expensive than brown rice, Quinoa packs a huge protein punch. In fact, it is the only grain that is a complete protein on its own, delivering 9 grams of protein per cup!

As far as "meat substitutes" are concerned, there are now countless brands and varieties of veggie burgers on the market, and like any other product, quality, price and flavor can vary widely. If you try one veggie burger and don't like it, try another brand. The chances are that there is one brand out there that has your name on it, and all you have to do is identify which one that is!

If you're open to experimentation, there are many vegetarian and vegan protein sources that are well worth exploring, including vegetarian "lunch meat", sausage, bacon, kielbasa, and countless other tofu-based products.

Tempeh is a fremented soybean product that is firm and easy to grill or fry. Many veggie burgers are made from tempeh due to its hearty consistency, and there are now a variety of flavored tempehs to choose from.

Tofu, a vegetarian stand-by for decades, is often derided as being bland. However, the secret to tofu is learning how to cook it correctly. Try buying extra firm organic tofu, slicing it in 1/2-inch slices. Heat a cast-iron or other non-stick pan on medium to high heat with a high-quality oil. Lay the tofu slices on the oil carefully (they will splatter, so be careful!) and then add soy sauce or tamari. Sprinkle some cayenne pepper or other spices, and lower the heat slightly. Fry until golden brown and crisp.

Seitan (say-ton) is a meat-like textured food made from wheat, so avoid this product if you have gluten intolerance. Seitan is excellent in stews and stir-fries. Some vegetarians who miss the texture of chicken like seitan-based products for that reason alone.

Lastly, look in the frozen section of many supermarkets and health food stores, where you will find countless varieties of soy-based protein dishes and textured vegetable protein (TVP)-based products.

Eating meals without meat or animal products can be an adventure for some and a way of life for others. Variety is said to be the spice of life, so if you're feeling adventurous, try a few of these products and let us know what you think.

Bon apetit.

The world has speeded up to an incredible pace, and we are all racing against the clock. Life takes on a life of its own, and the speed at which we live our lives is often blindingly fast. How do we make ourselves take a break and relax amidst the tumult? How do we quell our anxiety?

For one, I find that the first thing I can do is simply sit in a chair. If I can be intentional about my sitting and make it more of a meditation, then all the better. But if I can at least manage to just sit and breathe and feel my weight in the chair, just a few deep breaths can cause my nervous system to "take a chill" and simply let go. Many people use alcohol to relax, and others use cigarettes, drugs, shopping or sugar. For me, sitting and relaxing and just allowing myself to "be" is one of the keys to my mental health, and all too often I forget to practice even this basic tool of self-care.

This world daily conspires against our desire for leisure, and even what may seem like a leisure activity---gambling at the casino, taking the family to the mall---can all too often seem like work, as well. Sometimes we just need to be alone and still, and that moment of stillness and a few deep breaths can certainly do one's nervous system wonders.

As I sit here writing this post, I am well aware that I myself need to take a few deep breaths, sit for a moment, and allow my nervous system to find its way to a place of relaxation and stillness.

So, I will finish this post, publish it to Black Doctor, fold my hands in my lap, and sit in my chair and allow my breath to flow in and out as I watch my mind come to rest. Then I'll make a cup of tea, enjoy its aroma and warmth, and carry on with my evening. Taking a moment to rest one's mind amidst the insanity of the day is my prescription for today, and I encourage you, dear Reader, to do the same. Care to join me in a nice deep breath?

If you are one half of a married or committed couple in which one of you lives with depression, what do you do to help your marriage survive? Depression impacts many millions of Americans, and its effects on marriages and committed partnerships can be devastating.

According to the Centers for Disease Control and Prevention (CDC), 1 out of every 20 Americans lives with depression. And if 15 of those Americans are married or in a committed long-term relationship, then those 15 spouses also lives with depression---in their spouse. Add those figures up, and there are many more millions of people struggling with depression in their lives, whether it be their own or their spouse’s. And if one were to take into consideration the impact of one person’s depression on that person’s children, coworkers, friends, productivity and health, then the economic, societal and interpersonal impact of depression is truly beyond calculation.

So, if you or your partner are depressed, then, whether you like it or not, you actually have a third party in your relationship, and it has the potential to accompany you on every vacation, at every anniversary, and at every holiday, birthday and weekend. If this description speaks to you, then there are things that you can do to work with this third partner in your marriage or relationship.

First, talk about it. Keeping the lines of communication open is essential. Both the depressed partner and the non-depressed partner need to be open with one another, communicate their needs, and engage in individual and/or marital psychotherapy on a regular basis.

Next, make sure you both get regular exercise and eat well. Exercise can increase levels of important neurotransmitters, and a balanced whole foods diet low in sugar, processed foods, caffeine and alcohol can help to facilitate improved mental health and feelings of well-being. Another way to combat the impact of depression on relationships is to stay in touch with family and friends, and maintain relationships and friendships beyond the household.

The effects of depression can take a toll on a couple’s social life, facilitating feelings of isolation and loneliness. For the non-depressed partner, this may mean going out alone when the depressed partner is feeling too down to go out. Just because one half of the partnership is feeling like being alone doesn’t mean the other half has to play along. And maintaining active friendships is key to the non-depressed partner’s ability to have his or her needs met outside of the relationship in a healthy and constructive way.

Depression is serious, and oftentimes treatment with antidepressant medications is necessary. If the depressed partner is in psychotherapy or counseling, make sure that the therapist is kept up-to-date on the state of the marital relationship. And if the individual in treatment is showing signs of thoughts of harming his- or herself, then that person should be taken for treatment immediately, or at least make a call to a local, regional or national suicide prevention hotline like 1-800-SUICIDE.

Living with depression is difficult, and living with a depressed person is equally as difficult. Make sure that each individual takes care of him- or herself, seeks treatment as needed, and that the lines of communication remain open. Take advantage of professionals with expertise in depression and marriage, and make sure that you do not become isolated from friends and family, especially when times are tough. With 1 out of 20 Americans living with depression, you are certainly not alone. Make sure you don’t try to “go it alone”, and make sure you reach out for the help that you need when you need it.

For those living with Irritable Bowel Syndrome, diverticulosis, chronic constipation or other gastrointestinal syndromes, eating enough fiber on a daily basis is one of the keys to gastrointestinal health. Fiber has also been shown to decrease the risk of heart disease and some forms of cancer. Fiber serves as the bulk (or "roughage") of your body's digestive throughput, and this fibrous content---along with plenty of water---is essential to keeping your colon clean, decreasing the risk of diverticulosis, and keep intestinal motility normal.

Most women should have a daily intake of 21 to 25 grams of fiber, while men should take in 30 to 38 grams per day. When it comes to fruits, raspberries are very high, delivering 8 grams of fiber per cup. One pear (with skin intact) gives approximately 5 grams of fiber. For grains, oat bran and barley are filled with fiber, and and one cup of oatmeal has 4 grams of fiber. If you like legumes, 1 cup of split peas has 16 grams of fiber, and lentils have at least 15 grams per cup. In terms of veggies, peas, broccoli, corn, and potato with skins are all packed with healthy fiber.

Whether you are living with chronic gastrointestinal problems or want to prevent them, keeping your fiber intake high is key to promoting overall health. If you do indeed have diverticulosis, chronic constipation or irritable bowel syndrome, then fiber should be one of your primary dietary concerns.

If you are uncertain whether your fiber intake is adequate, or if you have concerns about increasing it on your own, consult your doctor or a registered dietician or nutritionist. But if you are comfortable with fruits, vegetables, grains and legumes, try your hand at some of your favorites, introduce some new items, and monitor how you feel as you increase. Note that a sudden and drastic increase in fiber intake can cause bloating and gas and abdominal discomfort, so increase your intake slowly over time.

Based on many conclusive scientific studies, household mold has been clearly shown to contribute to the development or exacerbation of respiratory illnesses and asthma. Some studies suggest that it is the mold itself that causes asthma, while other studies have concluded that perhaps it is the dust mites that live in damp environments that contribute to respiratory problems.

Mold spores have been shown to cause headaches, respiratory inflammation, rashes, nausea, and changes in lung function, among other repercussions. Either way, mold in your household is an issue that must be reckoned with, and individuals with respiratory conditions need to seriously consider if mold may be contributing to their symptoms. When considering children and asthma, the presence of mold has been shown to double the risk of developing asthma during childhood.

So, when it comes to mold, one of the most highly recommended actions to take is to have your home tested for mold. While this can be costly, the potential cost of not having mold identified could be far worse down the road, with chronic illness and worsening of preexisting respiratory conditions a potential consequence.

Here are a few tips for reducing mold in your home: Make sure you have working exhaust fans in all bathrooms. These fans must vent to the outside of the house, not just into the wall or ceiling. Quickly repair any leaks in plumbing. Do not use rugs or carpets in bathrooms where dampness is a concern. Scrub bathtubs, sinks and other surfaces regularly that might harbor mold. Clean refrigerator door gaskets and drip pans regularly. Raise the temperature in the basement. Use a high-quality dehumidifier year-round. Avoid bedding made with polyurethane or foam, as these harbor mold. Throw away or recycle old books, clothes and bedding that are prone to dampness. Keep vegetation away from the foundation of the house.

If you are a renter and are concerned about mold, contact your local Board of Health for information regarding your rights in terms of mold abatement. Mold is a serious problem for those individuals who have asthma and other respiratory conditions, as well as for those who do not. Studies have concluded time and again that mold spores are indeed a cause for concern for everyone's health, and if you do indeed have asthma or another respiratory condition, please consider how you can determine if mold is playing a part in your life and home.

People living with asthma must always be vigilant about their health, and one way to help keep one's asthma stable is to avoid triggers which will begin the downward spiral of worsening symptoms and the need for urgent medical attention.Practically speaking, many triggers can be avoided through simple hygienic practices that lessen one's exposure to known triggers of asthma.

Here are some pointers:

1) Maintain a shoeless household: dust and dirt from the outdoors can add to the amount of dust and dirt in your home. Taking shoes off at the door and maintaining clean and dust-free floors is one way to reduce the load of dust in the air of your home.

2) Remove carpets and rugs: rugs and carpets hold the dust and dirt and cane be home to dust mites and other microscopic insects that trigger breathing difficulties in people with asthma.

3) Switch to fragrance-free: use fragrance-free personal care products and "free and clear" laundry and household cleaners. Volatile chemicals and compounds in many common personal care products and cleaning products are known to cause respiratory distress in asthmatic and healthy individuals.

4) Keep your home clean: a clean home has less dust, fewer dust mites, and fewer overall triggers that will exacerbate your asthma symptoms

4) Avoid smoke: second hand smoke irritates airways and can cause acute asthma symptoms. If you still smoke and have asthma (or someone in your family does), pursue smoking cessation through a program or your medical provider.

5) Steer clear of mold: moldy basements and homes wreak havoc with asthma. If you live in a moldy home, move out if you can. If you can't, research ways to mitigate the mold growth in your home. Mold spores can be breathed into the lungs and trigger asthmatic symptoms.

These are only a few suggestions for how to avoid basic asthma triggers in the home. I will further explore this subject in subsequent posts pending further research. this short list is a good start, and we are happy to hear your comments on how you manage your asthma and avoid the triggers that exacerbate your asthmatic symptoms.

If you are thinking about painting the interior of your house, please consider your family's health when deciding what kind of paint to buy.

The Environmental Protection Agency (EPA) has stated that one of the five top risks to your health is indoor air. Paint fumes, toys, shower curtains and houeshold cleaning products can all emit Volatile Organic Compounds (VOCs) into the air of your home, triggering asthma, chemical sensitivity, neurological symptoms, and other environmental illnesses. Do you know that "new shower curtain smell"? That's not just the smell of something new. Those are VOCs being emitted right into the air that you breathe. That new car smell? The same thing.

So, when planning to paint the interior of your home, you must consider how those fumes will impact your health, especially the health of young children, the elderly, and those with chronic health conditions. However, bear in mind that even healthy people can be affected negatively by these compounds, triggering the development of short- and long-terms symptoms and illnesses.

Paints come in several forms, and when shopping at your local dealer, you will want to discuss your options with the salespeople. If they do not seem knowledgable, find someone who is. Here are a few options you may see on the shelves:

• Low Odor or Low VOC Paint
• Zero VOC Paint
• Non-Toxic or Natural Paint

Just as when you make a decision to purchase organic produce or meat, these healthier alternatives do cost more, and this is certainly something to take into consideration. But if you have small children at home, investing a few more dollars per gallon for paint that could directly impact their health is something very serious to consider.

The VOCs emitted by normal household paints can cause a host of serious health effects, and you certainly will not want to pay more for avoidable health care costs later on in order to save money on paint expenses now. Be penny wise and not pound foolish---low VOC paints can spare you and your family from unnecessary exposure to chemical compounds that can truly make you and your family acutely and chronically ill.