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Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss

Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss. Larry Bergstrom MD FACP Integrative Medicine Division of Consultative Medicine (CMED) Mayo Clinic Scottsdale AZ bergstrom.larry@mayo.edu Joanne Cacciatore, PhD Arizona State University School of Social Work.

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Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss

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  1. Grief, Stress, and the Body: Using Integrative Medicine to Cope with Loss Larry Bergstrom MD FACP Integrative Medicine Division of Consultative Medicine (CMED) Mayo Clinic Scottsdale AZ bergstrom.larry@mayo.edu Joanne Cacciatore, PhD Arizona State University School of Social Work

  2. Goals and Declarations 1) To define Integrative Medicine 2) To recognize the Medicine Wheel of Health 3) To know the three basic elements of health Declarations: None

  3. “Our greatest glory is not in never falling, but in rising every time we fall.” Confucius

  4. Stress A physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation Stimulates Sympathetic Nervous System • Adrenaline • Cortisol Increases blood pressure, heart rate, affects coagulation system, immune system, blood sugar, sleep

  5. An Exercise:Rate Your Stress Scale: 1-10, 10 is worst stress

  6. An Exercise:Rate Your Stress • Scale: 1-10, 10 is worst stress • Includes health, finances, family, neighbors, in-laws, work, global warming, politics, etc.

  7. An Exercise:Rate Your Stress • Scale: 1-10, 10 is worst stress • Includes health, finances, family, neighbors, in-laws, work, global warming, politics, etc. • How much of the day do you think about things on your stressor list?

  8. Rate Your Stress 1/10- Perfect idyllic life 5/10- Saber-toothed tiger is in the neighborhood somewhere 10/10- He’s breathing in your face

  9. Conventional Treatment of Stress

  10. Potential Complications of Chronic Stress Heart disease Sleep problems Digestive problems Depression Obesity Memory impairment Worsening of skin conditions, eczema

  11. Mortality and Bereavement Question: Does death of a child increase mortality of the mother? 69,224 mothers age 20–50 from National Longitudinal Mortality Survey, 9 yr follow-up, Results: Death of a child increases risk of death of mother by 133% especially in first 2 years. Not related to mother’s education or marital status, family size, the child’s cause of death or the gender of the child. Espinosa, J. Econ. Hum. Biol. (2012), http://dx.doi.org/10.1016/j.ehb.2012.06.002

  12. Conventional Medicine Focuses on treatment of physical disease, defined by measureable parameters; physical exam, lab tests, imaging, pathology, etc. Successful treatment is eradication or amelioration of the physical disease Ideal for acute care

  13. Definition- Integrative Medicine Comprehensive system that emphasizes wellness and healing of the whole person as major goals, above and beyond suppression of a specific somatic disease. Views the patient as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. BMJ. 2001;322:119-120.

  14. Integrative/Integrated Medicine Combines treatments from conventional medicine and CAM for which there is some high-quality scientific evidence of safety and effectiveness. National Center for Complementary and Alternative Medicine website

  15. Integrative Medicine Consultation Review: Medical condition(s) Conventional Medical Therapies Patient’s past and current use of CAM therapies. Potential interactions of CAM therapies with Conventional medical therapies Discern patient’s attitudes towards potential therapies; the patient’s value system.

  16. Integrative Medicine Consultation Develop an Integrated treatment plan incorporating: Exercise Nutrition Stress reduction Complementary and Alternative treatments tailored to the patient’s value system. How can we make the patient healthier?

  17. The Medicine Wheel-Physical Health This is Western, Conventional medicine, defined by measurement Examination X-rays Blood tests Tests give us name of the disease which we then treat the disease; however, what about when all tests are normal?

  18. Disease dis·ease A disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors

  19. Illness Patients suffer illnesses which are discrepancies between states of being and perceived role performances.

  20. The Medicine Wheel-Emotional Health Emotional Health Interface of Stress and Health through the sympathetic nervous system. “Fight or Flight” Saber-tooth Tiger analogy Patient rates stress level from 1 to 10, low to high

  21. The Medicine Wheel-Emotional Health Coping skills learned when younger are used to deal with stressful situations. Many people are: • Perfectionist • People pleasers • Ultra responsible • Theme- “need for control”, “lack of trust” • Very difficult to say “no” to anyone • Black and white thinking

  22. The Medicine Wheel-Emotional Health Mind-Body Medicine: enhance the mind's capacity to affect bodily function and symptoms. ↓ physical effects of Stress. Prayer Meditation Yoga, Tai Qi, QiGong Biofeedback Breathing Techniques Exercise

  23. Rumination Inward: Ruminating about the past: • Regret • Anger Ruminating about the future: • Fear • Anxiety Outward Living in the present • In front of you • Focused on the moment

  24. Mindfulness “Mindfulness means paying attention in a particular way; On purpose, in the present moment, and nonjudgmentally.” Jon Kabat-Zinn

  25. Mindfulness Exercise • Take 5 minutes • Pen and Paper • Find a peaceful and relaxing picture • Describe what you see in a non-judgmental manner • Write it down

  26. Therapeutic use of slow breathing Many favorable effects on the cardiovascular system and respiratory function • Decrease in vascular resistance: BP • Increase in peripheral blood flow • Improved exercise tolerance • Induce a sense of calm • Decrease anxiety

  27. RESPeRATE Proven in 10 clinical trials to lower blood pressure naturally. No side effects except for relaxation. Reduces stress

  28. Heart Math

  29. Combining MindfulnessandPaced Breathing • Think “I Am” • Breath in • 5 Seconds Think “At Peace” Breath out 5 Seconds 6 Breaths/Minute

  30. The Medicine WheelMental Health Neurochemistry- Psychiatry Target symptoms sleep appetite concentration energy sex drive Anxiety may be separate biochemical disorder Treatment- Antidepressants, correction of sleep disorder

  31. Target symptoms of Acute Grief/Depression • Sleep disturbance • Appetite disturbance • Concentration difficulties • Poor energy • Stamina • initiative • Loss of sex drive • Passive death thoughts • Hopelessness

  32. The Medicine WheelSpiritual Health History question: Do you have a spiritual part of your life that is helpful to you? What gives your life meaning? Defined by the patient. May be religious but not necessarily

  33. Spiritual Effect of IllnessMeaning Practices developed during health satisfying, fulfilling, enjoyable “charge our batteries” Illness, life changes may prevent engaging in them Deprives of energy, enjoyment, sense of control Can’t live up to self-expectations

  34. Spirituality The question: • “Do you have a spiritual part of your life?” • “What gives your life meaning?”

  35. Spirituality Activities developed during health Satisfying, fulfilling, enjoyable Charge up our batteries May all be lost through accident, illness other life changes and lead to a “spiritual crisis”

  36. What gives our life meaning? • Work • Faith • Family • Hobbies • Volunteering • Pets • Art • Sports To be a parent

  37. Spirituality In Short: • “Why do you get out of bed each day?”

  38. Spiritual Effect of Illness • The Ideal- State of health when one is able to do what is needed to feel fulfilled and give life meaning. • Developed during period of health “Spiritual Crisis” • The Reality of illness- State of health with illness/disability. When one is unable to do the things that give life meaning.

  39. Meaning and grief- Case 1 50 y/o women • 6 years ago, adopted son, age 13, killed while riding his bicycle • She grieves but remains positive • “I miss him terribly but he was a gift that I would not have otherwise. I am grateful for the time he was here.”

  40. Meaning and grief- Case 2 45 y/o man • 3 y/o daughter died 5 years ago • He decided no God could allow such a thing to happen • Deacon but abandoned his church • Divorced • Became a Hedonist- lives for pleasure only, because there is nothing beyond what we can see.

  41. Resilience A dynamic process (not a personality trait) encompassing positive adaptation within the context of significant adversity. Resilience is the result of individuals being able to interact with their environments and the processes that either promote well-being or protect them against the overwhelming influence of risk factors

  42. Resilience The process by which we find new things to give our lives meaning when the prior ones are unavailable or no longer possible

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