Breathe; Don’t Vent (At Least In The Moment)

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Zen And The Art Of Breaking Things

We’ve talked before about identifying emotions and the importance of being able to express them:

Answering The Most Difficult Question: How Are You?

However, there can be a difference between “expressing how we feel” and “being possessed by how we feel and bulldozing everything in our path”

…which is, of course, primarily a problem in the case of anger—and by extension, emotions that are often contemporaneous with anger, such as jealousy, shame, fear, etc.

How much feeling is too much?

While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?

For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently bad. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.

A good example of this is complicated grief and/or prolonged grief.

But what about when it comes to anger? How much is ok?

When it comes to those around you, any amount of anger can seem like too much. Anger often makes us short-tempered even with people who are not the object of our anger, and it rarely brings out the best in us.

We can express our feelings in non-aggressive ways, for example:

When You “Can’t Complain”

and

Seriously Useful Communication Skills!

Sometimes, there’s another way though…

Breathe; don’t vent

That’s a great headline, but we can’t take the credit for it, because it came from:

Breathe, don’t vent: turning down the heat is key to managing anger

…in which it was found that, by all available metrics, the popular wisdom of “getting it off your chest” doesn’t necessarily stand up to scrutiny, at least in the short term:

❝The work was inspired in part by the rising popularity of rage rooms that promote smashing things (such as glass, plates and electronics) to work through angry feelings.

I wanted to debunk the whole theory of expressing anger as a way of coping with it,” she said. “We wanted to show that reducing arousal, and actually the physiological aspect of it, is really important.❞

~ Dr. Brad Bushman

And indeed, he and his team did find that various arousal-increasing activities (such as hitting a punchbag, breaking things, doing vigorous exercise) did not help as much as arousal-decreasing activities, such as mindfulness-based relaxation techniques.

If you’d like to read the full paper, then so would we, but we couldn’t get full access to this one yet. However, the abstract includes representative statistics, so that’s worth a once-over:

A meta-analytic review of anger management activities that increase or decrease arousal: What fuels or douses rage?

Caveat!

Did you notice the small gap between their results and their conclusion?

In a lab or similar short-term observational setting, their recommendation is clearly correct.

However, if the source of your anger is something chronic and persistent, it could well be that calming down without addressing the actual cause is just “kicking the can down the road”, and will still have to actually be dealt with eventually.

So, while “here be science”, it’s not a mandate for necessarily suffering in silence. It’s more about being mindful about how we go about tackling our anger.

As for a primer on mindfulness, feel free to check out:

No-Frills, Evidence-Based Mindfulness

Take care!

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  • What You Don’t Know Can Kill You

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Knowledge Is Power!

    This is Dr. Simran Malhotra. She’s triple board-certified (in lifestyle medicine, internal medicine, and palliative care), and is also a health and wellness coach.

    What does she want us to know?

    Three things:

    Wellness starts with your mindset

    Dr. Malhotra shifted her priorities a lot during the initial and perhaps most chaotic phase of the COVID pandemic:

    ❝My husband, a critical care physician, was consumed in the trenches of caring for COVID patients in the ICU. I found myself knee-deep in virtual meetings with families whose loved ones were dying of severe COVID-related illnesses. Between the two of us, we saw more trauma, suffering, and death, than we could have imagined.

    The COVID-19 pandemic opened my eyes to how quickly life can change our plans and reinforced the importance of being mindful of each day. Harnessing the power to make informed decisions is important, but perhaps even more important is focusing on what is in our control and taking action, even if it is the tiniest step in the direction we want to go!❞

    ~ Dr. Simran Malhotra

    We can only make informed decisions if we have good information. That’s one of the reasons we try to share as much information as we can each day at 10almonds! But a lot will always depend on personalized information.

    There are one-off (and sometimes potentially life-saving) things like health genomics:

    The Real Benefit Of Genetic Testing

    …but also smaller things that are informative on an ongoing basis, such as keeping track of your weight, your blood pressure, your hormones, and other metrics. You can even get fancy:

    Track Your Blood Sugars For Better Personalized Health

    Lifestyle is medicine

    It’s often said that “food is medicine”. But also, movement is medicine. Sleep is medicine. In short, your lifestyle is the most powerful medicine that has ever existed.

    Lifestyle encompasses very many things, but fortunately, there’s an “80:20 rule” in play that simplifies it a lot because if you take care of the top few things, the rest will tend to look after themselves:

    These Top Few Things Make The Biggest Difference To Overall Health

    Gratitude is better than fear

    If we receive an unfavorable diagnosis (and let’s face it, most diagnoses are unfavorable), it might not seem like something to be grateful for.

    But it is, insofar as it allows us to then take action! The information itself is what gives us our best chance of staying safe. And if that’s not possible e.g. in the worst case scenario, a terminal diagnosis, (bearing in mind that one of Dr. Malhotra’s three board certifications is in palliative care, so she sees this a lot), it at least gives us the information that allows us to make the best use of whatever remains to us.

    See also: Managing Your Mortality

    Which is very important!

    …and/but possibly not the cheeriest note on which to end, so when you’ve read that, let’s finish today’s main feature on a happier kind of gratitude:

    How To Get Your Brain On A More Positive Track (Without Toxic Positivity)

    Want to hear more from Dr. Malhotra?

    Showing how serious she is about how our genes do not determine our destiny and knowledge is power, here she talks about her “previvor’s journey”, as she puts it, with regard to why she decided to have preventative cancer surgery in light of discovering her BRCA1 genetic mutation:

    Click Here If The Embedded Video Doesn’t Load Automatically

    Take care!

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  • What Your Brain Is Really Doing When You’re Doing “Nothing”

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Unless we are dead, our brain is never truly inactive. And it’s not just a matter of regulating autonomic functions, either…

    Default Mode Network

    When the brain is at rest but not necessarily asleep, the Default Mode Network (DMN) engages. This makes up for around 20% of the brain’s overall activity, and contributes to complex cognitive processes.

    What constitutes “at rest”: the DMN activates when external tasks stop and is engaged during self-reflection, mind-wandering, and relaxed memory recall (i.e. reminiscing, rather than answering questions in a difficult test, for example).

    As for its neurophysiology, the DMN is connected to the hippocampus and plays a key role in episodic, prospective, and semantic memory (memories of experiences, future plans, and general knowledge), as well as being involved in self-reflection, social cognition, and understanding others’ thoughts (theory of mind). The DMN thus also helps integrate memories and thoughts to create a cohesive internal narrative and sense of self.

    However, it doesn’t work alone: the DMN interacts with other networks like the salience network, which switches attention to external stimuli. Disruptions between these networks are linked to psychiatric disorders (e.g., schizophrenia, Alzheimer’s, depression), in various different ways depending on the nature of the disruption.

    Sometimes, for some people in some circumstances, the option to disrupt the DMN is useful. For example, research shows that psilocybin disrupts the DMN, leading to changes in brain activity and potential therapeutic benefits for depression* and other psychiatric disorders by enhancing neuroplasticity.

    *Essentially, kicking the brain out of the idling gear it got stuck in, and into action

    For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

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  • We’re only using a fraction of health workers’ skills. This needs to change

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    Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.

    There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.

    But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.

    These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.

    There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.

    A new vision for general practice

    I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.

    But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.

    The future of primary care is one involving more use of the range of health professionals, in addition to GPs.

    It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.

    This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.

    How about pharmacists?

    An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.

    This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.

    But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.

    Pharmacists explains something to a patient
    It’s often easier for a patient to see a pharmacist than a GP. PeopleImages.com – Yuri A/Shutterstock

    Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.

    GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.

    Who pays for all this?

    Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.

    Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.

    This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.

    In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.

    In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.

    The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.

    Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Related Posts

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  • Older Americans Say They Feel Trapped in Medicare Advantage Plans

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    In 2016, Richard Timmins went to a free informational seminar to learn more about Medicare coverage.

    “I listened to the insurance agent and, basically, he really promoted Medicare Advantage,” Timmins said. The agent described less expensive and broader coverage offered by the plans, which are funded largely by the government but administered by private insurance companies.

    For Timmins, who is now 76, it made economic sense then to sign up. And his decision was great, for a while.

    Then, three years ago, he noticed a lesion on his right earlobe.

    “I have a family history of melanoma. And so, I was kind of tuned in to that and thinking about that,” Timmins said of the growth, which doctors later diagnosed as malignant melanoma. “It started to grow and started to become rather painful.”

    Timmins, though, discovered that his enrollment in a Premera Blue Cross Medicare Advantage plan would mean a limited network of doctors and the potential need for preapproval, or prior authorization, from the insurer before getting care. The experience, he said, made getting care more difficult, and now he wants to switch back to traditional, government-administered Medicare.

    But he can’t. And he’s not alone.

    “I have very little control over my actual medical care,” he said, adding that he now advises friends not to sign up for the private plans. “I think that people are not understanding what Medicare Advantage is all about.”

    Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans’ share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers’ aggressive sales tactics and misleading coverage claims.

    Enrollees, like Timmins, who sign on when they are healthy can find themselves trapped as they grow older and sicker.

    “It’s one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing,” said Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

    “But it’s when they actually need to use it for these bigger issues,” Huberty said, “that’s when people realize, ‘Oh no, this isn’t going to help me at all.’”

    Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses, which the insurers can use to provide supplemental benefits. Huberty said those extra benefits work as an incentive to “get people to join the plan” but that the plans then “restrict the access to so many services and coverage for the bigger stuff.”

    David Meyers, assistant professor of health services, policy, and practice at the Brown University School of Public Health, analyzed a decade of Medicare Advantage enrollment and found that about 50% of beneficiaries — rural and urban — left their contract by the end of five years. Most of those enrollees switched to another Medicare Advantage plan rather than traditional Medicare.

    In the study, Meyers and his co-authors muse that switching plans could be a positive sign of a free marketplace but that it could also signal “unmeasured discontent” with Medicare Advantage.

    “The problem is that once you get into Medicare Advantage, if you have a couple of chronic conditions and you want to leave Medicare Advantage, even if Medicare Advantage isn’t meeting your needs, you might not have any ability to switch back to traditional Medicare,” Meyers said.

    Traditional Medicare can be too expensive for beneficiaries switching back from Medicare Advantage, he said. In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care, Meyers said.

    To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or a private Medigap policy. If they are low-income, Medicaid may provide that supplemental coverage.

    But, Meyers said, there’s a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.

    Only four states — Connecticut, Maine, Massachusetts, and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.

    Paul Ginsburg is a former commissioner on the Medicare Payment Advisory Commission, also known as MedPAC. It’s a legislative branch agency that advises Congress on the Medicare program. He said the inability of enrollees to easily switch between Medicare Advantage and traditional Medicare during open enrollment periods is “a real concern in our system; it shouldn’t be that way.”

    The federal government offers specific enrollment periods every year for switching plans. During Medicare’s open enrollment period, from Oct. 15 to Dec. 7, enrollees can switch out of their private plans to traditional, government-administered Medicare.

    Medicare Advantage enrollees can also switch plans or transfer to traditional Medicare during another open enrollment period, from Jan. 1 to March 31.

    “There are a lot of people that say, ‘Hey, I’d love to come back, but I can’t get Medigap anymore, or I’ll have to just pay a lot more,’” said Ginsburg, who is now a professor of health policy at the University of Southern California.

    Timmins is one of those people. The retired veterinarian lives in a rural community on Whidbey Island just north of Seattle. It’s a rugged, idyllic landscape and a popular place for second homes, hiking, and the arts. But it’s also a bit remote.

    While it’s typically harder to find doctors in rural areas, Timmins said he believes his Premera Blue Cross plan made it more challenging to get care for a variety of reasons, including the difficulty of finding and getting in to see specialists.

    Nearly half of Medicare Advantage plan directories contained inaccurate information on what providers were available, according to the most recent federal review. Beginning in 2024, new or expanding Medicare Advantage plans must demonstrate compliance with federal network expectations or their applications could be denied.

    Amanda Lansford, a Premera Blue Cross spokesperson, declined to comment on Timmins’ case. She said the plan meets federal network adequacy requirements as well as travel time and distance standards “to ensure members are not experiencing undue burdens when seeking care.”

    Traditional Medicare allows beneficiaries to go to nearly any doctor or hospital in the U.S., and in most cases enrollees do not need approval to get services.

    Timmins, who recently finished immunotherapy, said he doesn’t think he would be approved for a Medigap policy, “because of my health issue.” And if he were to get into one, Timmins said, it would likely be too expensive.

    For now, Timmins said, he is staying with his Medicare Advantage plan.

    “I’m getting older. More stuff is going to happen.”

    There is also a chance, Timmins said, that his cancer could resurface: “I’m very aware of my mortality.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • 3 Health Things A Lot Of People Are Getting Wrong (Don’t Make These Mistakes)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s time for our weekly health news roundup, and this week we’re putting the spotlight on…

    Don’t Dabble In dubious diabetes Drugs

    Diabetes drugs are in hot demand, both for actual diabetics and also for people who want to lose weight and/or generally improve their metabolic health. However, there are a lot of claims out there for products that simply do not work and/or are outright fakes, as well as claims for supplements that are known to have a real hypoglycemic effect (such as berberine) but the supplements in question are not regulated, so it can be hard to control for quality, to ensure you are really getting what it says on the label.

    As for the prescription drugs specifically (such as metformin, or GLP-1 RAs): there are online black market and gray market pharmacies who offer to sell you prescription drugs either…

    • no questions asked (black market), or
    • basic questions asked (e.g. “are you diabetic?”), and a doctor with flexible morals will rubber-stamp the prescription on the basis of your answers (gray market).

    The problem with these is that once again they may be fakes and there is practically no accountability (these sorts of online pharmacies come and go as quickly as street vendors). Furthermore, even if they are real, self-medicating in this fashion without the requisite expert knowledge can result in messing up dosages, which can cause all sorts of issues, not least of all, death.

    Read in full: The dangers of fraudulent diabetes products and how to avoid them

    Related: Metformin For Weight-Loss & More

    There is no “just the flu”

    It’s easy, and very socially normal, to dismiss flu—which has killed millions—as “just the flu”.

    However, flu deaths have surpassed COVID deaths all so recently this year (you are mindful that COVID is still out and killing people, yes? Governments declaring the crisis over doesn’t make the virus pack up and retire), and because it’s peaking a little late (it had seemed to be peaking just after new year, which would be normal, but it’s enjoying a second larger surge now), people are letting their guard down more.

    Thus, getting the current flu vaccination is good, if available (we know it’s not fun, but neither is being hospitalized by flu), and either way, taking care of all the usual disease-avoidance and immune-boosting strategies (see our “related” link for those).

    Read in full: Report indicates this flu season is the worst in a decade

    Related: Why Some People Get Sick More (And How To Not Be One Of Them)

    The hospital washbasins that give you extra bugs

    First they came for the hand-dryer machines, and we did not speak up because those things are so noisy.

    But more seriously: just like hand-dryer machines are now fairly well-known to incubate and spread germs at impressive rates, washbasins have come under scrutiny because the process goes:

    1. Person A has germs on their hands, and washes them (yay)
    2. The germs are now in the washbasin (soap causes them to slide off, but doesn’t usually kill them)
    3. Person B has germs on their hands, and washes them
    4. The splashback from the water hitting the washbasin distributes person A’s germs onto person B
    5. Not just their hands, which would be less of a problem (they are getting washed right now, after all), but also their face, because yes, even with flow restrictors, the splashback produces respirable-sized bioaerosols that travel far and easily

    In other words: it’s not just the visible/tangible splashback you need to be aware of, but also, that which you can’t see or feel, too.

    Read in full: Researchers warn about germ splashback from washbasins

    Related: The Truth About Handwashing

    Take care!

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  • Fast-Pickled Cucumbers

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Pickled vegetables are great for the gut, and homemade is invariably better than store-bought. But if you don’t have pickling jars big enough for cucumbers, and don’t want to wait a couple of weeks for the results, here’s a great way to do it quickly and easily.

    You will need

    • 1 large cucumber, sliced
    • 2 tbsp apple cider vinegar
    • 1½ tbsp salt (do not omit or substitute)
    • 3 cloves garlic, whole, peeled
    • 3 large sprigs fresh dill
    • 2 tsp whole black peppercorns
    • ½ tsp crushed red pepper flakes
    • 1 bay leaf

    Method

    (we suggest you read everything at least once before doing anything)

    1) Mix the vinegar and salt with 1½ cups of water in a bowl.

    2) Assemble the rest of the ingredients, except the cucumber, into a quart-size glass jar with an airtight lid.

    3) Add the cucumber slices into the jar.

    4) Add the pickling brine that you made, leaving ½” space at the top.

    5) Close the lid, and shake well.

    6) Refrigerate for 2 days, after which, serve at your leisure:

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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