The Wild Health Take: Week Four

Each week Dr. Carl Seger listens to your favorite podcasts to summarize the data and give you our precision medicine take.

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Who: #209 The DRIVE

What: Medical Mistakes, patient safety, and the RaDanda Vaught case

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1. In the 1990s, NYS set up a commission to look into the amount of medical mistakes that happen each year. The commission found that 44,000-98,000 people died each year from preventable medical mistakes (adverse events). This could have been caused by lack of proper systems to ensure doctors and residents weren’t overworked, it could have been caused by lack of supervision, or a cascade of everything going wrong at once could have been the cause. Since this study came out, there have been many systems put into place to improve the situation. However, there are still medical mistakes that happen every year in hospitals across the country.
2. RaDanda Vaught was a nurse at Vanderbilt University Medical Center in TN in 2017 when she made a fatal medical error, resulting in the administration of an incorrect medication to a patient, ultimately killing her. Vanderbilt covered the mistake by deeming the patient’s death from a brain hemorrhage and fired Vaught. This case is especially important because it brings to light how medical mistakes are handled in some hospitals, and can open the conversation around how to prevent these mistakes from happening in the future. It also opens the conversation around how these mistakes should be handled if they do occur.
3. There are ways you can become your own advocate to minimize your risk of a medical mistake happening to you. Bring a loved one or someone you trust with you to appointments whenever possible. This person should take notes, record pertinent information and advocate for you, if need be.

‍How: While the information in this podcast episode was rather unsettling, the truth is that there is so much we can learn from these experiences. It is important to always develop clear lines of communication including the communication between the patient and care team and within the care team, itself. Many mistakes are avoidable if we are able to create a culture in which everyone feels comfortable expressing concerns. Additionally, it is important to develop clear systems that the entire is confident in using and which ensures that there are documented protocols.

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Who: Andrew Huberman Ph.D., Professor of Neurobiology and Ophthalmology at Stanford School of Medicine

What: Therapy, Treating Trauma & Other Life Challenges

1. We define trauma as an event or experience that overwhelms our coping skills and results in a change in the way our brain functions. These changes are evident in our behaviors as we move through life. If a traumatic experience rises to the level of changing the functioning of our brain, it can lead to a state of shame or guilt and a subsequent attempt to bury or avoid the trauma. The origin of trauma is likely a response that was adaptive through evolution. However, it has become maladaptive in the current world. In the past, we lived much shorter lives and needed to adapt to remember negative experiences for our survival. Shame and guilt are powerful deterrents that control behavior allowing for society formation. These feelings reside in the limbic, or emotional, system which is aroused in the presence of fear, anger or “fight or flight” survival states of our nervous system. In our current culture, there is so much access to horrifying news and really powerful negative stories that lead us to be enthralled with all the events going on around us. These chronic and vicarious traumas create this same autonomic arousal as acute trauma and have a similar effect on our lives. These changes in our brains, if not managed correctly, can bring misery, suffering, addiction and even death.

2. Many of the behaviors related to traumatic changes are the result of the limbic system trying to soothe something that feels stuck inside. In trauma, people tend to avoid looking at the change within them. However, healing from trauma is a process of exploration, through written and verbal dialogue, about their new self, their new world, and their self-dialogue. To actually improve, one must review the trauma from a third-person perspective and find forgiveness and compassion for themselves. It’s often recommended to do this with speaking or writing, as our thoughts can differ with words. This can be done with a therapist, close friend, family member, clergy member, or trained professional. Details of the trauma do not need to be discussed, rather just a recognition that something happened and your feelings associated with it. Consider journaling if unable to access therapy. The right therapist builds a strong rapport; they pay attention, build trust, and adapt treatment modalities to their client’s needs.

3. Chemistry/Medications: There are no tests to determine if trauma is causing changes to neural circuits in the brain, so we tend to over-utilize medicine to achieve an outcome quicker. However, SSRIs have proven vast utility in assisting healing in therapy by improving distress tolerance and allowing them the ability to show up in place of being paralyzed by the symptoms. The class of antipsychotics used, even at low doses, can help intervene in negative distress pathways to avoid ruminations that are maladaptive. These medications will not heal someone, and should be used for short periods as an adjunct to therapy. Unfortunately, as a society, there has been over-medication instead of changing the scope to look closer at the source of the problem. Misused medications for ADD/ADHD, bipolar, or depression in the absence of those clinical disorders can have serious negative outcomes including addiction, impulsivity, judgment problems, and even psychosis.

4. Other substances including alcohol (ETOH), cannabis, ketamine, psilocybin, LSD, and MDMA have all been studied in the treatment of trauma. Often used as a coping mechanism, ETOH has proven the least utility in helping heal from trauma. It makes a person feel good momentarily but does not act as a catalyst for healing. Cannabis, used thoughtfully, narrows our cognitive perspective and can help us to be present and sleep better, both useful for trauma recovery. Psilocybin in a legal clinical setting is showing the most promise by quieting the outer cortex of the brain (language, vision, task completing) and into the insular cortex where they often have a release from circular thinking, fear, guilt, stress, shame, and anxiety to find compassion and empathy for oneself. This is also the outcome of psychotherapy, but the psilocybin studies are proving to be a huge catalyst in this process. MDMA floods the brain with serotonin and positive neurotransmitters which creates a greater permissiveness. However, guidance from a clinician is proving essential to avoid pitfalls that would negate the experience.

How: Caring for oneself is not to be underestimated in the process of healing from trauma, and it is straightforward. Sleep, getting sunlight in the eyes, interacting with good people, eating healthy whole foods, exercising, positive language, and self-talk are all essential to the healing process in the brain. Find a trusted individual or a trained professional, don’t avoid the hard work of therapy, be kind to yourself and others, and don’t overlook the basics of self-care.

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‍Who: High Intensity Health with Mike Mutzel, MS

What:  How Blood Sugar Imbalances Age Your Skin, Joints

1. Hyperglycemia and poor metabolic health create the formation of advanced glycation end-products on collagen proteins.The inflammatory environment affects skin elasticity, acceleration of wrinkles, thickness of hair, nail strength and joint health. It weakens tendons through calcification and makes them prone to rupture, injury and reduced mobility. Click here and here for articles referenced.
2. Poor metabolic health instigates changes at the cellular level. The creation of advanced glycation end-products occurs when glucose attaches to proteins, altering the structure and function of the protein.  
3. Indication of advanced glycation end-products can be evaluated by testing HgA1c, fasting glucose, insulin and liver enzymes. These health markers relate to metabolic health.
4. Collagen supplementation alone will not enhance production in the presence of a hyper-palatable processed food diet or inflammatory environment.
5. Improvements to metabolic health can be achieved through a nutritional intervention that aligns carbohydrate consumption with activity, lower sugar intake, increase in weight training, intervals and by walking after eating.

‍How: Improved collagen production is achievable and attainable to our patients through coaching lifestyle interventions that improve metabolic health.

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Who: Tara Brach

‍What: Cultivating a Courageous Heart-Part 1

1. We live with an illusion that we aren’t supposed to live with vulnerability. That if we feel it, we are weak. It is human nature to avoid living in a vulnerable state at all costs. We need achieve tolerance: the ability to stay and sit with our feelings. When we avoid vulnerability, we walk into fear-based anger, hate and shame. We have to move through vulnerability to get to courage.
2. How do we get to a courageous state? Pay attention to the anger and hatred we feel and see. There is typically unprocessed fear here. You cannot open your heart unless you process that fear and lean into your vulnerability.
3. How do we transform vulnerability into compassion? Hershey Jones Halifax shares the metaphor, “Strong back & soft front.” For mature compassion, you need a strong back and a soft front.
4. ‍Always remember: The light comes from the cracks, imperfections and places of vulnerability when allowed. Vulnerabilities can bring light and love into our lives. Our world deeply needs this light and love. Therefore, attending to our vulnerability is important to the greater good of the world.

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How: Cultivating a courageous heart is part of our due diligence to positively impact society, especially given the current state of the world.

1. Pay attention to feelings of anger, hate and shame.
2. Be vulnerable to those feelings and gain comfort in recognizing their presence.
3. Associate belonging and strength to these feelings in order to process and overcome.

Remember: The light comes from the cracks, imperfections and places of vulnerabilities when we tend to them.

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