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Rethink New Year’s Resolutions

I really love this article by Dr. Anna Settle. Such a great perspective and very informative.
— Dr. Dale


At the outset of each year, we vow to be more intentional about making better choices for ourselves. However, at the close of January, the novelty typically wears off and people tend to place much less emphasis on achieving their goals than they do for the first month of the year.

Why do our goals seem to fade so quickly? Often, people make resolutions to lose a certain number of pounds, fit into a certain size, or earn a specific salary. These goals, while made with the best of intentions, are not the most psychologically savvy means of achieving long-term self-satisfaction.

The most impactful part of goal setting and achievement is the time and process that is implemented in order to reach the goal itself. The process of creating a method by which you will reach a goal, and then actually sticking to that journey, is the most psychologically sound method for making a long-lasting, self-satisfying change. So, while losing 10 pounds may be a relatively realistic goal, simply subtracting those pounds from your total weight will not lead to the meaningful outcome that you desire.

Typically, when people vow to lose weight, what their psyche is actually saying is that that they are unhappy as-is. Ten pounds will not cure unhappiness. Completing a marathon will not change how you fundamentally feel about yourself. It is the process by which these goals are achieved that actually contributes to increased self-esteem and well-being. Thus, the lifestyle change that is made when working to be healthier, and the camaraderie and teamwork that results from training for a race are what actually improve self-esteem and increase happiness.

As we strive to keep our resolutions in place for the entirety of the year, here are some tips for increasing self-esteem by creating meaningful, reachable goals that will render long-term happiness and self-satisfaction.

1. Don’t quantify your goals. Setting a relatively arbitrary number based on what you think is “successful” is going to leave you with short-lived happiness. 1) Losing 10 pounds, 2) closing five business deals, and 3) going to the gym three times per week — the successful completion of these goals is focused simply on the outcome. The more psychologically savvy way of stating these goals would be: 1) to eat more healthily as a means of feeling physically better 2) modifying your business strategy so as to make you a more influential consultant, 3) carving time out in your schedule for exercising in order to increase energy level and improve mood throughout the week. These goals are similar, yet the latter ones focus on the process rather than the outcome.

2. Don’t set goals in absolutes. For example, if your goal is to give up sugar yet you decide to eat cake at a party, then you have, by definition, failed to meet your goal. There are a few habits that are harmful even in small doses but, for the most part, indulging occasionally is not going to be detrimental. In fact, from a psychological perspective, if we allow ourselves to have the cake periodically, we are going to place less value on having it regularly. However, if we formulate a goal of absolutely no dessert eating, then we place more value on the “forbidden” behavior and crave it to a higher degree. Ultimately, the goal is not to give up sugar, the goal is to focus on including more nutritious foods in your diet in order to feel better and improve your health.

3. Make sure that your goals are your goals. So often, we set standards for ourselves based on what society tells us is important. Social media fuels the desire to keep up with others’ expensive vacations, airbrushed waistlines and trendy purchases. When formulating goals, it is imperative to spend time assessing the goal, the process and the outcome. Ask yourself, does this goal align with my values? Will this goal contribute to long-term happiness? Will the time and effort I put into this goal be a meaningful way to spend my life? Asking these questions on a larger scale may help with introspection and creating goals that are a reflection of how you want to spend your time and energy.

Ultimately, goals are tools for improving. They are not tests, nor are they pass/fail. Goals should be positive, encouraging, helpful methods of guiding us along a path that coincides with our values and mission. So, if we are able to use this framework to establish some goals for the upcoming year, at the very least, we will stay on track and be mindful of how we are choosing to spend our time. That, in and of itself, will contribute to being more psychologically healthy and content.


Dr. Anna Settle is a psychologist and relationship expert who has a private practice located on Music Row in Nashville. Visit drannasettle.com and follow her on Twitter @drannasettle and Facebook.com/DrAnnaSettle.

ADHD Common in Adults With Epilepsy

This is so interesting.
Ever think you have ADHD? Speak to me during your next visit. We can refer you to a specialist.
— Dr. Dale



ADHD Common in Adults With Epilepsy

Megan Brooks

January 19, 2015

Nearly 20% of adult epilepsy patients report symptoms of attention-deficit/hyperactivity disorder (ADHD), a rate much higher than of the general adult population, a new study shows.

Epilepsy patients with ADHD symptoms also have higher rates of anxiety and depression and worse seizure frequency.

"Little was previously known about the prevalence of ADHD symptoms in adults with epilepsy, and the results were quite striking," first author Alan B. Ettinger, MD, director, Epilepsy Center at Neurological Surgery, PC, in Lake Success, New York, noted in a statement.

"To my knowledge, this is the first time ADHD symptoms in adults with epilepsy have been described in the scientific literature. Yet, the presence of these symptoms may have severe implications for patients' quality of life, mood, anxiety, and functioning in both their social and work lives," said Dr Ettinger, professor of clinical neurology, Albert Einstein College of Medicine, New York City.

The study was published online January 15 in Epilepsia.

Screen for Psychosocial Troubles

The investigators surveyed 1361 adults with active epilepsy as part of the Epilepsy Comorbidities and Health (EPIC) study. A total of 251 (18.4%) were classified as experiencing significant ADHD symptoms on the Adult ADHD Self-Report Scale, version 6 (ASRS-6), a rate four times higher than the 4.4% rate of ADHD in the general adult population.

Adults with epilepsy who had ADHD symptoms were nine times more likely to have depression and eight times more likely to have anxiety symptoms than their peers without ADHD symptoms. They also reported lower quality of life and worse physical and social function and were more likely to be unemployed.

"This study reinforces the fact that we have to broaden our view of what epilepsy entails," Dr Ettinger said. "Our patients may also have psychiatric comorbidities, and screening for and treating these may make a great difference to patients in their family, school, and work lives."

"Physicians who treat epilepsy often attribute depression, anxiety, reduced quality of life, and psychosocial outcomes to the effects of seizures, antiepileptic therapies, and underlying central nervous system conditions," he added.

"Our findings suggest that ADHD may also be playing a significant role. However, we don't know yet if ADHD in epilepsy is synonymous with ADHD in the general population, which is often responsive to treatment," Dr Ettinger said.

"As a next step, we need to validate measures to screen for ADHD specifically in epilepsy and clarify the nature of ADHD symptoms in adults with epilepsy. This will lay the foundation for future trials of treatments that offer the promise of rendering major improvements in the quality of life of adult epilepsy patients," he said.

The study was funded by the Leslie Munzer Neurological Institute. Janssen Scientific Affairs provided data access. Data analysis was performed by Vedanta Research. Dr Ettinger has served on advisory boards for Upsher-Smith, Eisai, Sunovion, and UCB and as a consultant to Ortho-McNeil Janssen Scientific Affairs LLC. The original article contains a complete list of author disclosures.

Epilepsia. Published online January 15, 2015. Abstract

Medscape Medical News © 2015  WebMD, LLC 
ADHD Common in Adults With Epilepsy. Medscape. Jan 19, 2015.

11 Reasons Dehydration Is Making You Sick And Fat

I love this! Dehydration is often one of the leading causes of symptoms I see in my office. I hope this changes the way you view the importance of drinking water.
— Dr. Dale

Adverse effects from not drinking enough water include digestive, skin, bladder and kidney problems, fatigue, and even headaches. We need water as much as the air we breathe in! Keeping your body hydrated is not a joke.

Did you know that dehydration actually sets in just before you start feeling thirsty? Sipping water throughout the day is the best way to handle it. Always have a bottle or a glass of water handy! If you’re not a morning person, having two glasses of water right after you wake up will boost up your blood pressure to normal levels, and it’s way healthier than having your first coffee on an empty stomach.

Many of us believe that merely drinking fluids like sweetened juices, soda or tea will hydrate you as well as water does. This is not true. It’s actually the opposite! To deal with the excess sugar and salt you are taking in your body wastes immense amounts of precious water just to clean it out from your system. And if you love your coffee, make sure to drink one extra glass of water for every cup you have.

Drinking water regularly speeds up your metabolism and makes you feel more ‘full’. You will eat less once you start drinking more! It’s the safest and healthiest way to lose weight. Drink up!

Wait. Everyone Has Hemorrhoids? (Yep, Even You)

This is great!! -- Dr. Dale


Everyone Has Hemorrhoids (Yes, Even You)


Scott - TodayIFoundOut.com

Much like bathroom-humor at the dinner table, hemorrhoids can be a taboo subject. The truth is, everyone has them.

Their job is to protect your anal sphincter muscles (the ones that open and close your anus) and to help keep your anus closed when you have moments of increased abdominal pressure, like when you're coughing. They become a problem for us when they become inflamed. Once this happens they're known as piles. Popular culture has led to "hemorrhoids" and "piles" to be interchangeable in common vernacular. By the age of 50, about half of the US population will have dealt with these inflamed itchy protrusions from your anus. Because most people with piles get curious about why their butt itches, let's take a closer look at what they are, what causes them to become inflamed, and how we can prevent that from happening.

Your anus is controlled by one of the many sphincter muscles within the body. Sphincters are muscles that form like a doughnut around the many openings within the body, like the entrance and exit of your stomach. Those would be the lower esophageal sphincter and pylori sphincter respectively. When sphincters relax, they allow the entrance or release of liquids and solids. Normally sphincters are constricted which keeps those liquids and solids from leaving their respective positions within the body. No one likes the acid from your stomach coming back up and making your chest feel like it's on fire!

As mentioned before, your anal sphincter is cushioned by hemorrhoids. Hemorrhoids themselves are made up of what are known as modified squamous epithelium. These highly vascular cushions reside along the anal canal in three main areas- the left, right and back of the canal. They are made up of elastic connective tissue and smooth muscles. Many of them do not contain muscular walls like arteries and veins do. Because of this, they are technically known as sinusoids (a small blood vessel like a capillary) and can swell up due to blood not being able to leave.

When you're relaxed, they provide about 15-20% of the pressure keeping your anal canal closed. When you have an increase in abdominal pressure, like when sneezing, the blood going back to your heart through your inferior vena cava is reduced. This causes these vascular cushions to swell up with blood pushing on your sphincter, and thus, help prevent the infamous anal-leakage. It's also thought that hemorrhoids are responsible for helping us determine the exact content of what's coming out, like gas versus a solid bowel movement.

When your hemorrhoids begin to swell up chronically, they begin to cause problems. This is when they become known as piles. Once they are piles, they can cause symptoms like hard lumps that can be painful and itchy, the feeling like you still have to go to the bathroom after you've already gone, and mucous discharge or bright red blood while defecating.

Anything that causes an increase in your abdominal pressure can cause your hemorrhoids to become chronically inflamed. Thus, there risk factors for piles- things like being pregnant, chronic constipation, lifting heavy weights, straining when passing stool, being obese, and increasing age. Some studies have even suggested the tendency to develop piles is inherited.

You have two types of piles, internal and external. A line known as the dentate line is what differentiates them. Located below the dentate line is external piles. These are covered by a type of skin called Anoderm that contain nerve fibers, specifically fibers connected to the pudendal nerve. The cause of the itchy pain is revealed!

Internal hemorrhoids are broken down in to 4 classifications. 1st degree protrude only into the anal canal. 2nd degree protrude outside the canal but go back in spontaneously. 3rd degree require you to push them back in manually, and 4th degree don't go back in to your canal no matter what you do.

The treatment for your piles depends on severity. If only minor, your doctor may choose to simply treat the symptoms, administering things like corticosteroids to reduce inflammation, laxatives if constipated, pain medication and anti-itch creams, as well as advising you to attempt not to strain while on the toilet, and to use simple pads to help with irritation.

If your pile is more cumbersome, your doctor can choose to remove or reduce the pile. They can do this in a variety of ways. Banding involves placing an elastic band around the base, cutting off blood-flow to the pile. After a few days, it will die and simply fall off. They can inject medications into the pile causing it to shrink, known as sclerotherapy. Surgery is also an option. They can remove the pile (hemorrhoidectomy), or staple shut the blood-flow to the pile itself.

In the end (pun intended) we all have hemorrhoids. Scratch your bums with pride knowing that 50% of us will have theirs inflame by the time we're 50. Let's just hope it's only a minor inflammation, because no one wants a Doctor cutting anything off down there!