Compassion In Action Coupled with Wellbeing

Last November I attended an event entitled Compassion In Action that Dr. Sonnee Weedn  organized with guest Humanitarian Buddhist Monk Lama Tenzin Choegyal. Words cannot express how peaceful and inspiring the morning retreat was in which he blessed our work and inspired all of us. Lama Tenzin Choegyal shared his spiritual path and adventure that started in 2000 when he traveled with his two brothers through the Upper Dolpo region of the Himalayan border between Nepal, India and Tibet. During his journey he rescued abandoned and neglected children and founded an orphanage called the Children’s Education Development (CED) Society (http://www.cedhouse.org).  At the present time there are over twenty children that are being educated and many are attending college.  You can watch Walk the Waking Journey, an 80-minute documentary that is a four part series on YouTube that describes Lama Tenzin Choegyal’s journey with the children of the CED house.  The children are being educated, loved, and are being raised to go back to their villages and/or be of service to the community at large.

The seed of attending this retreat was planted last July when I attended His Holiness, The 14^th Dalai Lama’s 80^th birthday party. I brought my husband one day and my sister and dear friends the next day.

Nobel Peace winners had all of us shouting “I have the power” as a reminder that we ALL can contribute with acts of love and compassion towards one another. 

The desire to make an impact on a more global level was in my mind and I felt as though I would be traveling to India at some point soon – it was a deep inner knowing.  When I met Lama Tenzin Choegyal and Dr. Sonnee Weedn in November of 2015 there was an unspoken shared alliance of being of service for OUR children.  Dr. Weedn and I exchanged emails about her work as a transformational psychologist throughout the year and ways we could collaborate.  I have humbly accepted her invitation to travel as her guest to Dharmsala, India to attend the 4^th International Conference of Men-Tsee-Khang (Tibetan Medical Society) this October in which the topic will be:  “Causes, Conditions and Remedies of Depression.” Dr. Weedn was invited to speak again by invitation from His Holiness, the 14^th Dalai Lama and Men-Tsee-Khang.   It is a great honor to have interviewed Dr. Weedn on my podcast this week in which we discussed many interesting topics with great emphasis on integrative wellness strategies.

Dr. Weedn discussed her presentation “8 Ways of Wellbeing” which is a compilation of the research Roger Walsh M.D., Ph.D. at U.C. Irvine that she presented at the 3^rd International Conference of Men-Tsee-Khang (Tibetan Medical Society) in 2015.

Here are the 8 essential ingredients to good mental health or TLCs (Therapeutic Lifestyle Changes):

1. Exercise – “Move it or lose it.”
2. Relationships- “Friends can be good medicine.”
3. Relaxation- “Examples are meditation and practicing mindfulness.”
4. Time in Nature- ”Just twenty minutes of fresh air can be therapeutic.”
5. Giving Back- “Acts of altruism.”
6. Nutrition- “Honoring your body with healthy food choices.”
7. Spiritual Practice- “Finding a community that emphasizes the practice of compassion and forgiveness.”
8. Recreation- “It is important to play!”

To hear a more in depth evidence based research about the TLCs above, you can listen to my interview with Dr. Weedn here: https://www.drdenisemd.com/2016/07/dr-sonnee-weedn-ph-d-csat/

For more information on Roger Walsh M.D., Ph.D and his body of work check out: http://www.integralhealthresources.com/integral-health-2/therapeutic-lifestyle-changes/.

As a society we are living at a time when we are conditioned to getting “answers in real time” and with our advanced technology “instant gratification” is OUR new norm.  Many people can benefit from modern day medicine when it is of absolute necessity, yet too often the “quick fix” of a pill is desired and lifestyle habits are ignored. Medicine has its place yet a “pill is not a skill.” Dr. Weedn and I discussed the evidence based wellness strategies above and we both agreed that prevention strategies and maintenance habits are key for mental health and overall wellbeing.

I would love to see the key ingredients of Dr. Walsh’s Therapeutic Lifestyle Changes be implemented globally and introduced to elementary school aged children and perhaps be called “Therapeutic Lifestyle Behaviors.” In the Manhattan Beach elementary school system here in Southern California the children are benefiting from Goldie Hawn’s MindUp program, a research base program with 15 lessons based in neuroscience ( http://thehawnfoundation.org/mindup/). Students learn to self-regulate their behavior and mindfully engage in focused concentration required for academic success with an emphasis on kindness and compassion as well.

Can you imagine a comprehensive global integrative wellness program that would be part of our school systems that covers the material from the MindUP program coupled with the 8 Therapeutic Lifestyle Changes? If we introduce these lifestyle habits to our children at a young age we can focus on prevention and wellbeing and set them up for a lifetime of thriving and resiliency.

Dr. Weedn and I covered many more topics on the podcast this week including her neurocoaching practice, her integration of her spiritual knowledge and her heartfelt work as the author of  “Many Blessings A Tapestry of Accomplished African American Women”  (http://www.manyblessingsbook.com)! She described this book as her greatest accomplishment.

I would like to express my gratitude for Dr. Weedn’s acts of compassion,, wisdom and significant contributions to wellbeing.

Dr. Denise

Autism: Gender Differences In Girls

Autism advocate, author and recent Loyola Marymount University graduate, Christine Motokane, boldly states on my podcast this week, “I am breaking stereotypes.” Understatement.

Christine shares her triumphs and challenges as a female with autism who was diagnosed at age four. As a teen she read many books about autism that she described were “very clinical” as they had been written by doctors, educators, professionals and parents. They were factually useful, yet she was craving information from others who were living with autism. She admires and respects, Temple Grandin (templegrandin.com), American professor, author and world-renowned autism spokesperson who has written many of the books that she has found the most helpful. Christine’s book about her personal experience, “Working the Doubleshift. A Young Woman’s Journey with Autism” was written to inspire, educate and raise awareness about autism and gives insights as to what it is like to be a female living with autism at a time when there are more readily available services. She states, “We all will be touched by someone who has autism at some point in our lifetime.”

In March of 2014 the CDC estimated the prevalence of autism as 1 in 68 children (1 in 42 boys and 1 in 189 girls). Did you know that boys are diagnosed with autism at a much younger age than girls that have Autism Spectrum Disorder (ASD)?

Maia Szalavitz’s article in the 3/1/2016 Scientific American Mind entitled, “Autism-It’s Different in Girls” is cutting edge and cites behavioral and preliminary neuroimaging findings that suggest autism in girls manifests closer to typically developing males in their social abilities than typical girls or boys with autism. The estimate of 1 in 68 children in the U.S. having autism is speculated to be higher due to the undiagnosed girls on the autistic spectrum. The article spoke about girls with autism being harder to diagnose for several reasons, including criteria developed specifically around males and overlapping diagnoses such as obsessive-compulsive disorder or anorexia. Kevin Pelphrey, a leading autism researcher at Yale University’s world renowned Child Study Center spoke about how even he did not recognize the condition in his daughter Frances, who was diagnosed at age five. They went from doctor to doctor, “They kept saying, ‘Oh, you have a girl. It’s not autism.” The criteria for diagnosing autism spectrum disorder (ASD)-a developmental condition that is marked by social and communication difficulties and repetitive , inflexible patterns of behavior-are based on data derived almost entirely from studies of boys. Pelphrey is now leading a collaboration with researchers at Harvard, UCLA, and University of Washington to conduct a major study of girls and women with autism, which will follow participants from childhood to adulthood. I believe this research will be groundbreaking and eye opening to many of the gender differences in behavior that we see not only in autism but in children’s mental health issues in general.

Christine addressed the many gender differences and biases she experienced first hand in her book, and during my podcast this week she shared: “Girls are better at masking their behavior.” Christine spoke about being initially diagnosed with attention deficit hyperactivity disorder, before getting her diagnosis of autism. Her speech delays, social interactions, sensory issues, and hyperactivity coupled with an astute observation from a relative led to an assessment at the regional center when she was four years old which started her path of intervention for autism. In her late preschool years she attended an invaluable six-week program at UCLA in which she made a lot of progress and the doctor told her Mom, “that I was going to be high functioning and that academics wouldn’t be a problem. However, I would struggle socially.” Christine has gratitude for “her village of support” which throughout the years has included her parents, relatives, behavioral therapists, doctor, aids, mentors, educators and other professionals. She writes about her village, and her experience on her blog~ redefiningnormalayoungwomansjourney.blogspot.com/.

Christine eloquently describes how dealing with a day at school can be exhausting from an emotional and a sensory perspective. “I think I have always had anxiety.” To cope with stress she takes walks once or even twice in a day, she also finds jumping relaxing; her “moving meditations.” She has cognitive strategies that she has learned from her behavioral therapy that are part of her daily thrive plan. She is passionate about raising awareness for the need to have a better support system for individuals with ASD when transitioning out of high school and into adult and college life. She and I discussed the need for a mentoring system. This would be much like a buddy system with other individuals that have autism that can mentor a younger person that is newly navigating the social challenges of having ASD. Christine has a lot of information and insight and is a self advocate on the Board of Autism Society for Los Angeles; you can follow her on Facebook by going to Working the Double Shift: a Young Woman’s Journey with Autism.

Here are some tips if your child is having social delays or behavioral issues:

-If your child is having social delays or restrictive interests, early assessment is key for your child to thrive. Ask your pediatrician for referrals to behavioral health professionals in your area.

-Pediatricians, educators, occupational therapists, and speech pathologists are often the first people to recognize social or behavioral issues with your child. Be open and receptive to observations, referrals and assessments. Knowledge is power.

– I highly recommend: New York Times Best Seller “NeuroTribes” by Steve Silberman as well as the “Thinking Person’s Guide to Autism: What you really need to know from autistic people, professionals and parents” by Emily Willingham, Jennifer Byde Myers, and Liz Ditz . Parents and teens in my practice have found these books very helpful!

I have exponential gratitude and inspiration for Christine Motokane for sharing her experience and wisdom with “US” this week. Thank you Christine!

Dr. Denise

Mental Health & The Importance of Sleep

“Psychiatrists and psychologists were like our version of superheroes,” a comment Ilana Glazer, actress, comedian, and previous student at NYU made about her experience with the CAMS (Child and Adolescent Mental Health Studies) program.  As Vice Chair for Education and Professor of Child & Adolescent Psychiatry and Pediatrics at the NYU School of Medicine, Dr. Jess P. Shatkin has contributed significantly to child psychiatry and is a true visionary in mental health education. As Founder and director of the nation’s largest undergraduate child development program, CAMS, he is leading the way in integrating tangible, engaging curriculum for our college students.  During the podcast this week he discusses the wide variety of classes that students can take at NYU while enrolled in the CAMS program on topics such as sleep, divorce, positive psychology and more! This is an example of an integrative mental health education curriculum that can have a life long ripple effect of tips and tools for wellbeing and hopefully attract some bright minds into working with children as educators, psychologists, psychiatrists or other mental health providers.

Why is it so important to encourage our youth to be aware of the importance of mental health and hopefully recruit them into the field?

We are experiencing a crisis in the ability to provide the mental healthcare for our children and there is a shortage of child psychiatrists in the USA. According to the American Academy of Adult and Child Psychiatry, there are approximately 8300 practicing child and adolescent psychiatrists in the United States- and over 15 million youths in need of one.  I have worked  > 40,000 patient hours since finishing my child psychiatry fellowship at UCLA in 2001, and I can let you know firsthand that being at the front line of mental health care is eye-opening.

Did you know that 70-80% of lifelong mental health issues begin in childhood?

I believe that all of the current practicing child psychiatrists need to “step up” to inspire, contribute, and collaborate on the mental health crisis that we are facing at this time in history. It is vital that we as a society embrace, integrate and encourage our children to strive for inner peace, happiness and wellbeing starting as early as possible.  Why? Being educated and empowered about your mental health is vital for happiness.

When individuals thrive, we all thrive.

Dr. Shatkin has started a “Mental Health Revolution” at the undergraduate level and he will be leading a consortium this fall in which other universities will model their programs after the NYU CAMS program.

Are you ready for an example of a CAMS course?

Dr. Shatkin teaches a sleep course at NYU entitled “While you were sleeping” where students learn about the science of sleep, hygiene, evolution and dreams and how getting better sleep can help reduce depression and anxiety. How cool is that class? It is practical, real & engaging.  Cynthia Haddad, who took the course in the summer of 2013 told the HuffPost, “I learned basically everything about sleep. We learned how it affects our bodies. We learned about how sleep affects us in our waking hours- the brain, body, emotionally. I learned the following and try to keep to these rules: Do not use devices up to an hour before bed; no caffeine past noon; and use the bed only for sleep and sex-so that when you get into bed, your body knows it wants to sleep.”

Data is key in making recommendations of what works and does not work when modifying behavior.  In 2014, Dr. Shatkin and his colleagues compared sleep quantity and quality between NYU students taking his course and those not. Students in Dr. Shatkin’s class slept 22 minutes longer on average per night after two months into the course and fell asleep 9 minutes faster! Dr. Shatkin presented his data at the annual AACAP meeting (American Academy of Child and Adolescent Psychiatry) and discussed how his study also showed that better sleep hygiene is associated with fewer depressive symptoms and less anxiety!

A great way to understand your (or your child’s) sleep pattern is to keep a sleep log to share with your doctor, which you can download at: http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

The American Academy of Sleep Medicine recommends 7 or more hours of sleep for an adult.

As of June 13, 2016 The American Academy of Pediatrics (AAP) has issued a Statement of Endorsement supporting the American Academy of Sleep Medicine (AASM) guidelines outlining recommended sleep duration for children from infants to teens. The consensus group recommends the following sleep hours:

• Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health.

Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.

Prevention, wellness and early intervention are crucial for mental health for our children.  We spend 1/3 of our life sleeping. Can you imagine if all of our pediatricians, parents and educators were educated and encouraged children to focus on sleep hygiene at a very young age?

Adequate sleep, nutrition, exercise and meditation can prevent many trips to the doctors office.

I tell my patients that my goal is for you to spend the least amount of time in a doctor’s office and on no medication or the least amount needed.

Here are some “Sleep Tips”:

• Regulate your sleep rhythm with a regular wake up and bed time.
• Eliminate or do not have caffeine after noon each day.
• Avoid or minimize alcohol use.
• Do not use electronic devices one hour before bed.
• Try to exercise no later than four to five hours before going to bed as it raises your body temperature which can make it difficult falling asleep (if you are exercising before bed and are having no difficulty falling asleep-keep exercising!)
• Use your bed for sleep or sex only.

Thank you Dr. Jess Shatkin, you are truly an inspiration to all of “US”! Your superhero cape is on its way to NYU.

Now – let’s start sleeping better!

Dr. Denise

Protect Your Brain

“Dr. Denise, you need to see the movie, Concussion, with Will Smith. It depicts exactly what I have experienced living with depression and dementia, ” encouraged Gary Goodridge, legendary MMA UFC and Pride fighter.  That is exactly what I did before interviewing him this week. I didn’t stop there. I read his book “Gatekeeper: The Fighting Life of Gary ‘Big Daddy” Goodridge”, researched the NFL’s as well as the MMA’s policies on dealing with head injury, and read countless articles on CTE (Chronic Traumatic Encephelopathy).  In 2012 Gary was diagnosed with early onset dementia and depression and his doctors said that he was exhibiting symptoms similar to other professional athletes that on autopsy were diagnosed with CTE.

What is CTE? Dr. Bennet Omalu and colleagues in the Department of Pathology at University of Pittsburgh together published in the journal Neurosurgery in 2005 an article called, “Chronic Traumatic Encephalopathy in a National Football League Player.”  Dr. Omalu’s autopsy of former Pittsburgh Steelers Mike Webster in 2002 revealed large accumulations of tau protein in Webster’s brain, affecting mood, emotions, and executive functions similar to the way clumps of beta-amyloid protein contributes to Alzheimer’s.

According to the Brain Injury Research Institute founded by Dr. Julian E. Bailes, M.D.,Dr. Bennet  Omalu M.D. and Robert P. Fitzsimmons in 2002 ( protectthebrain.org ):

“Since the 1920’s the term dementia pugilistica or “punch-drunk“ syndrome has been known as it has occurred in boxers. Dementia pugilistica is actually a variant of chronic traumatic encephalopathy (CTE), which is itself a serious type of brain damage resulting from repeated concussions and is found in many professional athletes and military personnel who have been subjected to multiple impacts to the head.

Severe concussions and mild traumatic brain injury are both capable of causing CTE, and the likelihood of developing this condition is increased with the number of impacts.”

“Big Daddy”, Gary Goodridge has a true samurai spirit both in and outside of the ring.  He reports his medication is helping with aggression and depression. He has been given cognitive strategies to help him keep sharp with his recent cognitive decline: keeping a day planner to help with short-term memory and maintaining structure to his day.  Walking his dogs, and spending time with his daughters and family give him the most joy.  “The gym really helps me~my own workouts as well as teaching children keeps me inspired.” He spoke about this on the interview.  He also spoke about the need for rest in between fights and other tips he thinks could have helped him to minimize repeated head trauma.  “I would have had second thoughts about fighting if I knew then what I would be experiencing now,” he mentioned during another discussion. He and I spoke about his desire to provide for his family as well as his natural ability as a fighter keeping him engaged in the sport. Gary’s love of his daughters and his desire to be a role model and advocate for mental health awareness is giving him the hope and inspiration to fight on while living with depression and dementia.

In Discover’s July/August 2016 article by Jeff Wheelwright, “Ahead of the Hit,” it was pointed out that the science is still gray on CTE and predicting the effects of impacts.  Dr. Ann McKee and her group at Boston University continue to define and help with the consensus of the definition of the neurodegenerative disorder CTE.

In my professional opinion as a Mother and as a Doctor my consensus opinion is “Protect your brain and your child’s brain.” That is it.  It is common sense.

• Avoid or minimize head trauma.
• Avoid or minimize substance use.
• Seek out treatment for mental health and focus on lifestyle habits that promote well-being.
• If you or your child play a contact sport and are having any changes in behavior or changes in cognition contact your physician at early onset to prevent any long-term neurodegenerative consequences.

Routine physicals are mandatory for optimal health.

Our children need us to be advocates for their health and well being. If we can encourage participation in sports and extracurricular activities that minimize head trauma and concussions we are doing our job to protect our children.

Thank you, Gary Goodridge for sharing your story, you have taught me a lot and have inspired me in many ways.

Dr. Denise

Medication and Child Psychiatry

I am personally grateful that I went to medical school and became an Adult and Child Psychiatrist. Why? Because mental health is the most important part of a person’s well-being. Happy individuals with healthy thoughts create a society in which we can all thrive. We need to think of our children and our future. We need to get rid of the stigma of mental health and focus on mental wellness.

Did you know there is a shortage of Child Psychiatrists in the U.S.A.?

According to the American Academy of Adult and Child Psychiatry, there are approximately 8,300 practicing child and adolescent psychiatrists in the United States — and over 15 million youths in need of one.

I just attended an amazing MasterPsych conference presented by the American Physician Institute in Laguna, California last October. Guess what discussion I engaged my “kindred spirit” child psychiatry colleagues in during our lunch breaks?

Integrative mental wellness and collaborative care.

Using the least amount of medications.

Spending time with our patients.

We talked about the importance of tools such as solution oriented therapy, cognitive behavioral therapy (CBT), nutrition, exercise, yoga, meditation, parent training, and psychoeducation.   As doctors, we know how and when to prescribe medication and value all of the clinical trials that have been done to support the treatment when needed.

I believe that a Child Psychiatrist is the best person to decide if a child would benefit from being placed on a medication for behavioral issues. The dilemma we have is that there are not enough of us. We need to solve the problem of shortage of well-trained child psychiatrists and be a part of the solution for our children getting the proper treatment.

WE NEED A PARADIGM SHIFT. NOW.

Step one is getting rid of the stigma of mental health in our society. Doctors of all specialties and subspecialties need to respect and hold mental health in high regard. In medical school I excelled in many rotations as a third year medical student, even surgery. When I declared psychiatry as my residency choice there was a definite stigma from my colleagues. I moved forward with passion and strong conviction that psychiatry was the right fit for me. I believe that mental health is the foundation of all health and wellness. It should be integrated into all health care.

As Child Psychiatrists we need to be open to being part of the solution of attracting more medical students into our profession. We need to be thought leaders in supervising pediatricians on mental health diagnosis’. If we have a proper system in place then I believe the children will get the right treatment and be put on the least amount of medication.

Dr. Denise