So it is 2012, and what is different?  Since this is often the season of reflection and new resolution, I’ve been considering my own stuff.  I took a week off and let myself relax (good behavior), I also worked out five of seven days  (good), made contact with most of my good friends (good), hosted my daughter and her husband for a few days (very good), so why would I want to change anything?  Mostly I have observed myself eat high fat and sweet stuff uncontrolably (very bad), and in spite of being aware of what I was doing I did it anyway.  Awareness and consciousness does not equal good behavior, there is still choice.  So today I listened to a u-tube presentation about changing eating behavior to ward off heart disease.  The presenter Dr Esselstyn made a good case for dramtic eating changes. Similar to Dr Dean Ornish the changes involve very low fat or no fat without room for variations.  The motivation with this dramatic change is the fear of death, since most of the successful candidates have come to a point they may not be able to bennefit from other therapies, so they are forced into compliance.  Not a thrilling thought, but the change is remarkable and they litterally reverse heart disease.   This has caused me to pause, particullarly following the last couple weeks of excess, and consider this dietary possibility.  I must admit it seemed daunting to consider being without meat, fowl, fish, or any kind of fat, but if the payoff is living a life free of heart disease it might just be worth the effort.  While it is not a commitment, I do think about all those wonderful people in my life who bring me so much joy and how much I love being with them, this effort can have payoffs.  There are also payoffs with energy, concentration, and sex because of improved blood flow and increased nitic oxcide.  It seems as tough passing the McDonalds today has more bennefits than the brief pleasure of the drive thru. We’ll see how well I do in the next couple hours.

Mindfuljoe

Batman and Robin were able to defend Gotham City from evil and almost single handedly.  They both had their unique ways and worked together to create an environment that fostered safety and security for the residents.  Depression and diabetes are a unique dynamic duo that also is very powerful, each capable of reaking havoc on a human being by itself.  They are also linked with each other and in combination can have a devastating effect on the humans who live with them.

Research has shown us that they are connected; sometimes diabetes happens first, sometimes depression happens first.  People who have diabetes are twice as likely to develop depression as those who don’t have diabetes.  The most frightening part is that each of these conditions can single handedly lead to disability, poor self care, difficulty concentrating, difficulty with sexual functioning and relationships, and both can take a huge toll on the overall health of the individual.  It is with this in mind that organizations such as the AADE (American Assn of Diabetes Educators) are recomending regular screenings for depression. Medical ceneters are increasingly screening for depression and hopfully this will have the positive impact we psychologists are desiring.  That impact is for more people to get treated for both diseases so they are not such a deadly duo.  If you think you may be experiencing either and have not been diagnosed plaese see a doctor, or a therapist for further screening.  You do not have to simply suffer with it or “pull yourself up by your own bootstraps”.  Have the courage to ask for the help you need.  Send me a response if you think you have depression and we’ll dialogue about it.  You can get better if both are treated the right way.  Take care, mindfuljoe

During this past week I attended a conference on  brain development and habit change, I also listened to a program on MPR about the adolescent brain, both of which are saying a number of similar things.  Essentially there are many aspects of brain development involving the hormone dopamine, self regulation, risky behavior, and limit setting.  It is clear in adolescence the nature of the brain is to take risks often beyond what parents wish, but the truth is this is critical for brain development in our teenagers.  The consequence of this is the teen brain begins to become altered in a way that moves it more in the direction of making what we consider better decisions (Safer, more mature).  This is a process that helps their brain development.  This doesn’t mean we just sit back and wait for it to happen but instead we need to continue to set the limits, talk about the need for better decisions, and process how this can happen by looking at the choices and consequences.  Someday we hope it works better and more often than not it does.  So some of the questions parents of children with diabetes may want answers to are what can be done all along the way to help foster better decisions and more responsible behavior.  I might suggest the following bullet points for children of all ages:

• Model responsibility : if you want them to do it, show them and tell them you are being responsible
• Understand their brain is not good at setting it’s own limits, (that part is still in development) so you need to help create a safe environment by setting the limits for them. Make it a Safe Container for them.
• Expect them to be responsible.  If we expect them to fail they will, if we expect success they will more often.
• Make sure the tasks are fitting for their age and knowledge base.  Set them up for success not failure.
• Don’t do it for them, let them make mistakes and help them process other options
• Keep life stimulating, if it becomes boring they will find a way to make it stimulating, (maybe not the safest alternative)
• Teach and coach responsible behavior, they won’t automatically know what to do.  yelling at them doesn’t get them to do it.  Set up behavior in approximations (small do-able tasks) that move in the direction of the overall goal.
• Start early and practice often.  Begin teaching responsibility as early as you can and keep doing it at every opportunity.  What ever our kids can do for themselves developmentally let them no matter how good they do it or how long it takes, it will pay off in the long run.
• Their brain is on it’s own schedule, it is our job to continue to coax it along even if it is not always willing.

I gave a presentation this week to a group of sales reps with Eli Lilly co.  Nice group and the topic was changing the behavior of health professionals related to their prescribing behavior.  One truth is we can’t really change somone’s behavior except our own.  Another truth is we sure can push hard enough to get someone to change, that it causes them to dig their heals in and actually get stuck in their old behavior.  What I spoke to the reps about was how to know who might be ready to change and how we can have a positive influence in the direction that would be ideal for person doing the changing.  In other words how they can get out of their own way and not screw it up.  For most of us change is a long term process, that requires deep thought, good reasons to change, expected payoffs if we do change, and a real commitment to the process and outcomes of change.  Since I work with people who have diabetes and also those with sexual issues I see a great deal of mixed feelings about change due to fear, frustration, but also some realization that life can be a lot better if they are able to find the energy and direction to move.  It is really at the intersection of these mixed feelings that change can begin.  Let me know what you think and if you have been able to change patterns in your life.

Today I attended a meeting given by Ken Mitchell P.A.of Metro Urology. Great information given by someone who is compassionate and has a complete understanding of the process of treatment and recovery. I was impressed with his approach and reminded that treatment for any sexual issue is more than a medical issue. The approach needs to encorporate the partner wether straight or gay, it also must give support to the emotional and psychological issues that confront those recieving the treatment, but we (professionals) cannot assume the patient completely understands their needs or fully knows what is going to happen. It is critical to have an extensive conversation about their beliefs about sex and about the cancer and take the time necessary to walk with them throughout this entire time of diagnosis, treatment , and recovery. This may take anywhere from 6 months to several years. The good news – there is great hope for recovery. With the newer approaches to the physical therapy being used and a better understanding of this process for the patient and his partner, there appears to be a greater potential for recovery and less trauma with this surgery.