GEAR up for wellness

by John Chuck, M.D.

We live in a crazy busy and stressful world that often leaves us feeling overwhelmed and unwell. In his book Margin: Restoring Emotional, Physical, Financial, and Time Reserves to Overloaded Lives, family physician Richard Swenson sums up the problem well by concluding that we have created a life that is only endurable under sedation. Sure enough, my medical practice is filled with people who are burned out in multiple arenas of their lives. They come to my office asking for stimulants to keep them focused during the day and sedatives to help them sleep at night. In many cases prolonged stress and ineffective coping mechanisms lead to clinical depression and great difficulties at work and at home.

Another way to describe our ultra busy lives is to say that we are subject to multiple simultaneous conflicting imperatives. The acronym for this phenomenon is MSCI and it is appropriately pronounced "messy." The typical day in a MSCI life goes something like this: you wake up tired (pick a reason: sleep apnea, chronic back pain, a relationship gone sour that left you going to sleep angry, a neighbor who likes to play Def Leppard music at 3am); you go to the bathroom and you notice blood in your stool and on the toilet paper (but there was a burning and tearing sensation as you passed your stool so hopefully the blood is due a hemorrhoid rather than the colon cancer your sister had); you go to the kitchen for some breakfast and there's no milk for your cereal; your kids need breakfast and their lunches made; you are late for work which isn't good because you are already on probation; your manager makes unwanted sexual advances but you can't speak up because you are the only bread winner in your family and you are already buried in credit card debt; after you go out of your way to help an especially needy client, he files a formal complaint and accuses you of being aloof and uncaring; you get a call during an important lunch meeting that your son has been sent home with head lice; an computer meltdown at work delays your ability to turn in a report and so you work until 7:30pm to get the job done - which means that you've missed yet another one of your daughter's soccer games; you go home hoping for a nice quiet family dinner but find your kids eating frozen dinners because your spouse if out for yet another night of poker; said spouse comes home well fed and a little tipsy and brimming with an eagerness to talk about the state of your relationship; you have no desire to talk about relationships because you are tired and angry and so you put on some tennis shoes and head out to walk the dog and claim some wellness for yourself; when you walk fast you get chest pain, shortness of breath, and nausea - just like your neighbor did before he had a quadruple bypass surgery. And did I mention that the mail is piling up (and it's important stuff like automobile recalls, unpaid bills, and a fat letter from the IRS), your mother was in the emergency room again with another near fainting episode that her doctor can't figure out, there's a greasy puddle of liquid in your driveway where your car was parked, and your dog's anal glands need to be decompressed before they rupture on your living room couch. It's enough to drive you insane.

But wait. There's hope. The late John Gardner, President Johnson's Secretary of Health, Education, and Welfare who has been described as the engineer of the Great Society, had this to say about the human condition, suffering, and our ability to overcome great hardship: "For many this life is a vale of tears; for no one is it free of pain. But we are so designed that we can cope with it if we can live within some context of meaning. Given that powerful help, we can draw on the deep springs of the human spirit, to see our suffering in the framework of all human suffering, to accept the gifts of life with thanks and endure life's indignities with dignity."

Inspired by Gardner's profound insight and wisdom, my suggestion for your wellness woes in the face of MSCI is that you GEAR up for wellness by focusing on the following:

Gratitude - start each day by being grateful
"Gratitude is an opener of locked up blessings." - Marianne Williamson
When I was about ten years old my father, who was a minister in San Francisco's Chinatown for over forty years, told me that I should be grateful every morning I could wake up and pee. You can imagine how this comment made little sense to me as a fifth grader. It wasn't until ten years later while studying anatomy and physiology that I began to understand what my father meant - namely that we should never take for granted the miraculous ways that the human body works because soon enough those highly evolved functions like swallowing, micturating (peeing), speaking, and thinking will begin to falter - sometimes in the split second it takes to have a car accident, heart attack, or stroke.

Bob Emmons, a UC Davis professor of psychiatry and expert on gratitude, did some groundbreaking research on gratitude thinking with patients afflicted with neuromuscular diseases. He instructed a subset of the patients to engage in daily gratitude journaling. Specifically, he asked them to start out each day by writing down three new things they were grateful for that day. Several months in to the study, he discovered that the patients who did gratitude journaling twenty one days in a row or more had better health outcomes and mood scores than those patients who did not engage in the gratitude journaling. The positive effect of starting out each day by saying "Wow is me" as opposed to "Woe is me" was so impressive that Bob was awarded a $5.6 million grant from the Templeton Foundation to further investigate the science of gratitude.

To bring the gratitude message home with a bang, I invite you to enjoy this gratitude video by Louie Schwartberg and Brother David Steindl-Rast.

Exercise - exercise on a regular basis and many good things will follow
"Those who think they have not time for bodily exercise will sooner or later have to find time for illness." - Edward Stanley, Earl of Derby
Of all the epidemics in America, the most devastating one in terms of its effect on health is that of physical inactivity. Studies show that only 18% of adults follow the national recommendations for physical activity which call for 150 minutes per week of moderate intensity physical activity (such as jogging, swimming, brisk walking or raking leaves) and twice weekly sessions of muscle strengthening activities. That means that 82% of Americans are not enjoying the benefits of regular physical activity which include maintenance of muscle mass and reductions in obesity, diabetes, high blood pressure, heart attack, stroke, dementia, depression, and fatigue. If you are currently leading a sedentary lifestyle, the best way to start and sustain a physically active life is to pick an activity or activities you enjoy, set specific and achievable goals (such as walking for ten minutes three times a week), keep a record of your progress, and celebrate and reward your successes.

Click here for a compelling video about the benefits of exercise on health by Canadian family physician Mike Evans.

Adaptation - adapt to change by adopting best practices.
"It is not necessary to change. Survival is not mandatory." - W. Edwards Deming
We are living in an unprecedented era of large scale unpredictable and continuous change. Failure to acknowledge that change and to effectively adapt to it is a recipe for professional and personal failure. But rest assured, you don't have to discover all of the best ways to meet new challenges by yourself. It is perfectly OK to just adopt the best practices that you see in others. In his book Switch: How to Change When Change is Hard Chip Health from Stanford explains that throughout the history of mankind, individuals and groups have been constantly challenged by change. And when those challenges arise, there are always some people and groups who adapt in more effective ways. He calls these superior adaptors "bright spots" and encourages those who seek success to identify and copy these behaviors. Actively seek mentors and role models who somehow manage to deliver more services with less resources in the corporate world and masterfully adjust their marriage relationships to accommodate the children they have added to their growing families. You'll have trouble finding a single person who embodies all the best qualities without having some flaws so follow the lead of Napoleon Dynamite and create a "liger" (the perfect blend of a lion and tiger) who embodies the best traits of several of your favorite people minus their fatal flaws.

Relationships - invest in the relationships that give your life meaning and purpose.
"For there is but one problem - the problem of human relationships. We forget that there is no hope or joy except in human relations." - Antoine de Saint-Exupery
Richard Swenson would say that much of our unwellness results from our misguided attempts to find wellness in all the wrong places. In a society that places knowledge, wealth, and power on a lofty pedestal, we worship diplomas from esteemed universities, financial investment wizards, high tech IPOs, fast shiny cars, and memberships in exclusive country clubs. Yet Swenson and legions of other insightful people who have lived a little would argue that after you have satisfied your basics needs for food, clothing, and shelter, the vast majority of the wellness and meaning in your life is to be found in relationships with others (your social life), your self (your emotional life), and God (your spiritual life). In a similar vein, John Travis, widely recognized as the founder of the modern wellness movement, said that the currency of wellness is connection, not things. Here are some examples of how you might make connections in your three realms of relationships:

Social life: be a good listener; be a mentor; want for other people's children what you want for your own; dare to be vulnerable; remember that the appreciation of diversity begins with finding common ground; make a commitment to work with others for a cause greater than yourself; volunteer for something (anything). Look up from your iPhone, shut off your computer, and spend some 1:1 time with another human being. Discover the joy of listening, talking, and looking into someone's eyes.
Emotional life: learn how to be comfortable with yourself and set aside time to be by yourself; engage in a mindfulness practice; live in the moment, unfettered by failures from your past and fears about the future; consider professional counseling to help process your life experiences and to learn how to tell yourself a better story.
Spiritual life: if you believe in a loving God, be open to his leading for your life; consider that what you don't understand is not nonexistent or irrational, bur rather transrational (beyond your understanding); respect the spiritual beliefs of others.

In summary, life is good but life can also be hard due to the fast paced, always changing, materialistic world we have created for ourselves. In this setting, your wellness can often take a back seat to the other competing priorities and distractions in your life. The solution to this dilemma is to focus on gratitude, exercise, adaptability, and relationships as deep springs of goodness that will bring meaning, purpose, and wellness into your life.

I'll end with this video from the late Dr. Lee Lipsenthal who reminds us to Enjoy Every Sandwich during our brief time on this earth. I'm sure that if he were alive today he would join me in admonishing you to not wait until you have a terminal diagnosis to discover the power of love, connection, and simplicity in a life well lived and lived well.

References:
John Gardner, a great America hero
Greatness Redefined by James Chuck
The Emmons Lab at UC Davis
Brene Brown on the Power of Vulnerability
Richard Swenson: Restoring Margin to Overloaded Lives
Empathy: The Human Connection to Patient Care from the Cleveland Clinic

How focusing in Gratitude, Exercise, Adaptation, and Relationships can help you be more well