Wellness
This is a companion webpage for my talk on Wellness for the CASFAA (California Association of Student Financial Aid Administrators) meeting that I gave on 10/23/22 . https://www.casfaa.org/conferences
(I started this page for an International Ombuds Association (IOA) Webinar that I gave on August 12, 2021 https://ioa.mclms.net/en/package/3925/course/8344/view#course-content .)
The topics discussed below are not intended as medical advice. These are publicly available articles that I found interesting. If you decide that you want to change your routine, please consult your physician. Stay safe.
If you have any comments please e-mail me at nolan.kagetsu@mssm.edu
Thank to to the IOA for giving me the opportunity to talk about wellness (This was supposed to be a live talk in Portland in 2020!)
Thank you also to Veronica Basadre, who saw my IOA webinar and invited me to give the keynote presentation on wellness at CASFAA!
As I worked on my talk I realized how much I am using material from Kaki Okumura. I am grateful to her for meeting with me and chatting about wellness! She breaks things down into "4 pillars" of wellness.
https://kakikata.space/%e5%88%9d%e5%bf%83%e8%80%85%e3%81%b8%e3%80%81the-kaki-philosophy/
My talk follows this structure
Rest/Sleep-
Diet
Healthy weight/BMI
Diet-
Activity-
Stretching
Walking
Social
Other
Microbreaks
https://ehs.stanford.edu/subtopic/microbreaks
Mental Wellness
Meditation
Pitfalls/disclaimer
Sadly meditation has resulted have experienced terrible consequences for some
For example, those with PTSD have experienced exacerbations.
https://www.acesconnection.com/blog/meditation-may-aggravate-trauma-mindful-action-is-a-better-alternative
Before taking the MBSR course, you have to sign a disclaimer acknowledging potential risks , for example
https://ct1.medstarhealth.org/content/uploads/sites/16/2016/07/MBSR-Informed-Consent-Agreement.pdf
An article from Harpers
https://harpers.org/archive/2021/04/lost-in-thought-psychological-risks-of-meditation/
Science
decreased size amygdala (jumpy superhero)
Altered Traits- Goleman, Richardson
Buddhism
Christian meditation
Stress
Square breathing
I attended a presentation at the NYFD headquarters. They train the firefighters to use "Square breathing" when they are in stressful situations. Square breathing is a simple way to mitigate stress in the moment.
https://blog.zencare.co/square-breathing/
An article by Dr. Emma Seppala
https://emmaseppala.com/6-quick-easy-mindfulness-tips-combat-holiday-stress/
MBSR
breathing without the "m" word for patients/visitors
I do procedures on patients who are awake and sometimes apprehensive. I ask them to take a deep breath through their nose and blow it out through their mouth. This often help reduce their anxiety. You don't even have to use the "m" word! Some colleagues have written article on this topic. One could argue this should be taught in medical school!
Reference by Mary Scott Soo https://www.jacr.org/article/S1546-1440(15)01360-5/pdf (Thanks to former resident Sumeet Bahl for this one!)
A recent article from JACR where they used mindfulness to decrease patient anxiety for breast biopsies
https://www.jacr.org/article/S1546-1440(18)31149-9/fulltext
Empathy
loving kindness
subway exercise
Self Compassion
see https://self-compassion.org/
Wellness Exercises
raisin/eating/hara hachi bu
nature/forest bathing Mindfull v mind full
ichi-go ichi-e "literal translatation: one time, one meeting" really means "treasuring the unrepeatable nature of a moment"
"We can never step in the same river twice"
-Heraclitus (535 – 475 BCE)
gratefulness
negative visualization
Performance
Mindfulness is part of Zen Buddhism, the religion of the samurai. Modern day warriors have tried to incorporate mindfulness to improve their performance as well.
https://www.mindfulleader.org/blog/16338-meditate-like-a-bad-ass-insights-from
Politics
Representative Tim Ryan (Ohio) is a fan of mindfulness. He wrote a book "Mindful Nation"
http://mindfulnationnetwork.com/
For further reading
https://centerhealthyminds.org/
"washing dishes" meditation
Financial Wellness
Max out 401K, Roth IRA
Physical Wellness
Diet
Goals
BMI
Normal weight = 18.5–24.9
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Asians should target a lower BMI
18.5-22.9
http://screenat23.org/wp-content/uploads/2015/10/BMIforAsianAndAsianAmericanAdults-EN.pdf
Okinawan centenarians have been lean throughout with an average body mass index (BMI) of 18 to 22
source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822182/ Learn about processed foods
A summary of the MIND Diet (Mediterranean-DASH Intervention for Neurodegenerative Delay)
https://www.alzheimers.gov/clinical-trials/mind-diet-prevent-cognitive-decline
Learn about the Japanese concept hara hachi bu
https://www.bluezones.com/2017/12/hara-hachi-bu-enjoy-food-and-lose-weight-with-this-simple-phrase/
Intermittent Fasting
A New England Journal of Medicine article on intermittent fasting
(I do the 16/8 to 17/7 version)
Exercise/Activity
Flexibility
Back health
As a neuroradiologist, I see the consequences of degenerative changes at work, every day
An interesting article about bending over properly (C vs. table bending (works with good hamstring flexibility))
Activity
30 active minutes 2-3x/week
Knee health
Try to get at least 3000 (ideally 6000 ) steps each day!
https://www.sciencedaily.com/releases/2014/06/140612085120.htm
Balance
Strength
Sleep
I've heard that you can determine how much sleep you need by seeing how much you sleep on vacation (with no alarms) Try to get this much sleep all the time. Sleep is important for brain heath. (I use a fitbit to track my sleep.)
https://www.brainandlife.org/articles/could-getting-more-high-quality-sleep-protect-the-brain/
http://depts.washington.edu/mbwc/news/article/the-cleansing-power-of-a-deep-nights-sleep
https://www.sleepassociation.org/about-sleep/stages-of-sleep/deep-sleep/
Other
Hearing Hack
Use the acoustic/stapedius reflex to your advantage
Vocalize when there is a loud noise
Glossary:
Blue Zone: Places in the world where the population live meaningful lives for a long time. e.g. see this reference https://en.wikipedia.org/wiki/Blue_Zone
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125071/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822182/
gaman: a Japanese phrase for "enduring the seemingly unbearable with patience and dignity ", resilience . There was a song Gaman in the play Allegiance https://www.youtube.com/watch?v=EunqF5gfyMo An interview with George Takei https://www.history.com/news/george-takei (I did see the play twice in NYC)
Hara Hachi Bu : This is the practice of eating until you are 80% full. (as opposed to eating until it hurts!) This is one of the reasons Okinawa is a Blue Zone (hachi is eight in Japanese.)
Ichi-go ichi-e :Japanese phrase for "treasuring the unrepeatable nature of a moment " literally means "one time, one meeting" (ichi is one in Japanese)
Ikigai : (pronounced ee-kee-ga-ee (this pronunciation is from a credible source (mom) as opposed to some you may have seen on-line) your reason to "get up in the morning"/what brings meaning to your life. (see blue zone)
a brief article http://theviewinside.me/what-is-your-ikigai/
Kintsugi: the Japanese art of repairing ceramics with gold to accent the repair. The resulting piece could be considered more beautiful than the original. an article on how
kintsugi is a metaphor for resilience https://www.lifegate.com/people/lifestyle/kintsugi see also the book Kintsugi Wellness by Candice Kumai
Mindfulness: as defined by Jon Kabat Zinn
the awareness that arises from
paying attention,
on purpose,
in the present moment and non-judgmentally
Nana korobi ya oki : fall down seven times and get up eight (literally: seven falls, eight getting up)
Shirin-yoku: Japanese phrase for forest bathing, being in a natural setting can improve our wellness an article from Time https://time.com/5259602/japanese-forest-bathing/
shikata ga nai: Japanese phrase for "it cannot be helped" commonly used by Japanese-American/Japanese Canadian internees during World War II, somewhat related to the
stoic philosophy of not spending time on things you cannot control
wabi-sabi: a Japanese phrase for appreciating imperfection. Artists would deliberately put an imperfection in their work. Apparently other cultures do this as well
https://www.bbc.com/travel/article/20181021-japans-unusual-way-to-view-the-world
https://www.amusingplanet.com/2017/08/the-art-of-deliberate-imperfection.html
http://mercury.lcs.mit.edu/~jnc/nontech/wabisabi.html
Books:
These are books I've read :
Mindfulness on the Go- Jan Chozen Bay, short book on how to incorporate mindfulness into your daily life
you are here- Thich Nhat Hanh
Buddhism Without Beliefs- Stephen Batchelor
Kintsugi Wellness - Candice Kumai
A Path with Heart- Kornfield
How to Change Your Mind- Michael Pollan
Mindful Work- David Gelles
The Doors of Perception - Aldous Huxley
Attending- Ronald Epstein
Altered Traits- Goleman, Richardson
Wherever You Go There You Are- Jon Kabat Zinn
Genius Foods- Lugavere, Grewal
Thoughts without a Thinker - Mark Epstein. M.D. (a psychiatrist who incorporates Buddhism into his practice) some interesting stories of folks benefiting from psychotherapy
Resources:
Be More America - a company based in NYC. I've attended some of their sessions. They use mindfulness to decrease unconscious bias. (See the tab on "Mitigating Unconscious Bias" for complementary strategies to reduce bias.)
Link to articles cartoons
mind full v mindful http://loricorbetmann.uk/mindfulness
a blog about mindfulness
A "cheat sheet" on meditation for beginners
The Honest Guide to Mindfulness by Leo Babauta (who also has a facebook page)
Meditation apps
I use the free version of Insight Timer
I went to a presentation by Micheal Acton Smith, the CEO of Calm, their competition is Headspace
Three things from the folks at Duke, a simple gratitude intervention to improve wellness and patient safety!
https://www.hsq.dukehealth.org/wellweb/