Coach’s Plan – by Mike Kavanagh
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A sports coach’s job is to prepare a plan, give it to the player(s), and hold them accountable to it. Change the strategy if needs be, call the shots. The job of the player(s) is then to follow those instructions.
If you have trouble keeping yourself accountable, Kavanagh argues that it can be good to separate how you approach things.
Not just “coach yourself”, but put yourself entirely in the coach’s shoes, as though you were a separate person, then switch back, and follow those instructions, trusting in your coach’s guidance.
The book also provides illustrative examples and guides the reader through some potential pitfalls—for example, what happens when morning you doesn’t want to do the things that evening you decided would be best?
The absolute backbone of this method is that it takes away the paralysing self-doubt that can occur when we second-guess ourselves mid-task.
In short, this book will fire up your enthusiasm and give you a reliable fall-back for when your motivation’s flagging.
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Hospitals worldwide are short of saline. We can’t just switch to other IV fluids – here’s why
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Last week, the Australian Therapeutic Goods Administration added intravenous (IV) fluids to the growing list of medicines in short supply. The shortage is due to higher-than-expected demand and manufacturing issues.
Two particular IV fluids are affected: saline and compound sodium lactate (also called Hartmann’s solution). Both fluids are made with salts.
There are IV fluids that use other components, such as sugar, rather than salt. But instead of switching patients to those fluids, the government has chosen to approve salt-based solutions by other overseas brands.
So why do IV fluids contain different chemicals? And why can’t they just be interchanged when one runs low?
Pavel Kosolapov/Shutterstock We can’t just inject water into a vein
Drugs are always injected into veins in a water-based solution. But we can’t do this with pure water, we need to add other chemicals. That’s because of a scientific principle called osmosis.
Osmosis occurs when water moves rapidly in and out of the cells in the blood stream, in response to changes to the concentration of chemicals dissolved in the blood plasma. Think salts, sugars, nutrients, drugs and proteins.
Too high a concentration of chemicals and protein in your blood stream leads it to being in a “hypertonic” state, which causes your blood cells to shrink. Not enough chemicals and proteins in your blood stream causes your blood cells to expand. Just the right amount is called “isotonic”.
Mixing the drug with the right amount of chemicals, via an injection or infusion, ensures the concentration inside the syringe or IV bag remains close to isotonic.
Australia is currently short on two salt-based IV fluids. sirnength88/Shutterstock What are the different types of IV fluids?
There are a range of IV fluids available to administer drugs. The two most popular are:
- 0.9% saline, which is an isotonic solution of table salt. This is one of the IV fluids in short supply
- a 5% solution of the sugar glucose/dextrose. This fluid is not in short supply.
There are also IV fluids that combine both saline and glucose, and IV fluids that have other salts:
- Ringer’s solution is an IV fluid which has sodium, potassium and calcium salts
- Plasma-Lyte has different sodium salts, as well as magnesium
- Hartmann’s solution (compound sodium lactate) contains a range of different salts. It is generally used to treat a condition called metabolic acidosis, where patients have increased acid in their blood stream. This is in short supply.
What if you use the wrong solution?
Some drugs are only stable in specific IV fluids, for instance, only in salt-based IV fluids or only in glucose.
Putting a drug into the wrong IV fluid can potentially cause the drug to “crash out” of the solution, meaning patients won’t get the full dose.
Or it could cause the drug to decompose: not only will it not work, but it could also cause serious side effects.
An example of where a drug can be transformed into something toxic is the cancer chemotherapy drug cisplatin. When administered in saline it is safe, but administration in pure glucose can cause life-threatening damage to a patients’ kidneys.
What can hospitals use instead?
The IV fluids in short supply are saline and Hartmann’s solution. They are provided by three approved Australian suppliers: Baxter Healthcare, B.Braun and Fresenius Kabi.
The government’s solution to this is to approve multiple overseas-registered alternative saline brands, which they are allowed to do under current legislation without it going through the normal Australian quality checks and approval process. They will have received approval in their country of manufacture.
The government is taking this approach because it may not be effective or safe to formulate medicines that are meant to be in saline into different IV fluids. And we don’t have sufficient capacity to manufacture saline IV fluids here in Australia.
The Australian Society of Hospital Pharmacists provides guidance to other health staff about what drugs have to go with which IV fluids in their Australian Injectable Drugs Handbook. If there is a shortage of saline or Hartmann’s solution, and shipments of other overseas brands have not arrived, this guidance can be used to select another appropriate IV fluid.
Why don’t we make it locally?
The current shortage of IV fluids is just another example of the problems Australia faces when it is almost completely reliant on its critical medicines from overseas manufacturers.
Fortunately, we have workarounds to address the current shortage. But Australia is likely to face ongoing shortages, not only for IV fluids but for any medicines that we rely on overseas manufacturers to produce. Shortages like this put Australian lives at risk.
In the past both myself, and others, have called for the federal government to develop or back the development of medicines manufacturing in Australia. This could involve manufacturing off-patent medicines with an emphasis on those medicines most used in Australia.
Not only would this create stable, high technology jobs in Australia, it would also contribute to our economy and make us less susceptible to future global drug supply problems.
Nial Wheate, Professor and Director Academic Excellence, Macquarie University and Shoohb Alassadi, Casual academic, pharmaceutical sciences, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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South Indian-Style Chickpea & Mango Salad
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We have a double-dose of chickpeas today, but with all the other ingredients, this dish is anything but boring. Fun fact about chickpeas though: they’re rich in sitosterol, a plant sterol that, true to its name, sits on cholesterol absorption sites, reducing the amount of dietary cholesterol absorbed. If you are vegan, this will make no difference to you because your diet does not contain cholesterol, but for everyone else, this is a nice extra bonus!
You will need
- 1 can white chickpeas, drained and rinsed
- 1 can black chickpeas (kala chana), drained and rinsed
- 9 oz fresh mango, diced (or canned is fine if that’s what’s available)
- 1½ oz ginger, peeled and grated
- 2 green chilis, finely chopped (adjust per heat preferences)
- 2 tbsp desiccated coconut (or 3 oz grated coconut, if you have it fresh)
- 8 curry leaves (dried is fine if that’s what’s available)
- 1 tsp mustard seeds
- 1 tsp cumin seeds
- 1 tsp black pepper, coarse ground
- ½ tsp MSG or 1 tsp low-sodium salt
- Juice of 1 lime
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Heat some oil in a skillet over a medium heat. When it’s hot but not smoking, add the ginger, chilis, curry leaves, mustard seeds, and cumin seeds, stirring well to combine, keep going until the mustard seeds start popping.
2) Add the chickpeas (both kinds), as well as the black pepper and the MSG/salt. Once they’re warm through, take it off the heat.
3) Add the mango, coconut, and lime juice, mixing thoroughly.
4) Serve warm, at room temperature, or cold:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- What Matters Most For Your Heart?
- Can Saturated Fats Be Healthy?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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Beating Toxic Positivity
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How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
There have been many studies done regards optimism and health, and they generally come to the same conclusion: optimism is simply good for the health.
Here’s an example we’ve mentioned before, but it’s a good introduction to today’s main feature. It’s a longitudinal study, and it followed 121,700 women (what a sample size!) for eight years. It controlled for all kinds of other lifestyle factors (especially smoking, drinking, diet, and exercise habits, as well as pre-existing medical conditions), so this wasn’t a case of “people who are healthy are more optimistic as results. And, in the researchers’ own words…
❝We found strong and statistically significant associations of increasing levels of optimism with decreasing risks of mortality, including mortality due each major cause of death, such as cancer, heart disease, stroke, respiratory disease, and infection. Importantly, findings were maintained after close control for potential confounding factors, including sociodemographic characteristics and depression❞
Read: Optimism and Cause-Specific Mortality: A Prospective Cohort Study
And yet, toxic positivity can cause as many problems as it tries to fix.
What is toxic positivity?
- Toxic positivity is the well-meaning friend who says “I’m sure it’ll be ok” when you know full well it definitely will not.
- Toxic positivity is the allegorical frog-in-a-pan saying that the temperature rises due to climate change are gradual, so they’re nothing to worry about
- Toxic positivity is thinking that “good vibes” will outperform chemotherapy
Sometimes, a dose of realism is needed. So, can we do that and maintain a positive attitude?
The answer is: somewhat, yes! But first, a quick check-in:
❝I’m not a pessimist; I’m a realist!❞
~ every pessimist ever
To believe self-reports, the world is divided between optimists and realists. But how does your outlook measure up, really?
While like most free online tests, this is offered “as-is” with the usual caveats about not being a clinical diagnostic tool, this one actually has a fair amount of scientific weight behind it:
❝Empirical testing has indicated the validity of the Optimism Pessimism Instrument as published in the scientific journal Current Psychology: Research and Reviews.
The IDRlabs Optimism/Pessimism Test (IDR-OPT) was developed by IDRlabs. The IDR-OPT is based on the Optimism/Pessimism Instrument (OPI) developed by Dr. William Dember, Dr. Stephanie Martin, Dr. Mary Hummer, Dr. Steven Howe, and Dr. Richard Melton, at the University of Cincinnati.❞
Take This Short (1–2 mins) Test
How did you score? And what could you do to improve on that score?
First, it’s said that with a big enough “why”, one can overcome any “how”. So…
An attitude of gratitude
We know, we know, it’s very Oprah Winfrey. But also, it works. Take the time, ideally daily, to quickly list 3–5 things for which you feel grateful. Great or small, it can be anything from your spouse to your cup of coffee, provided you feel fortunate to have it.
How this works: our brains easily get stuck in loops, so it can help to nudge them into a more positive loop.
What about when we are treated unfairly? Are we supposed to be grateful?
Sometimes, our less positive emotions are necessary, to protect us and/or those around us, and to provide a motivational force. We can still maintain a positive attitude by noting the bad thing and some good, but watch out! Notice the difference:
- “How dare they take our healthcare away, but at least I’m not sick right now” (lasting impression: no action required)
- “At least I’m not sick right now, but how dare they take our healthcare away!” (lasting impression: action required)
It’s a well-known idea in neurolinguistic programming, that “but” negates whatever goes before it (think of “I’m sorry but”, or “I’m not racist but”, etc), so use it consciously and wisely, or else simply use “and” instead.
Cognitive reframing: problem, or opportunity?
Most problems can be opportunities, even if the problems themselves genuinely suck and are not intrinsically positive. A way of leveraging this can be replacing “I have to…” with “I get to…”.
This not only can reframe problems as opportunities, but also calls back to the gratitude idea.
- Instead of “I have to get my mammogram / prostate exam” (not generally considered fun activities), “I get to have the peace of mind of being free from cancer / I get to have the forewarning that will keep me safe”.
- Instead of “I have to go to work”, “I get to go to work” (many wish they were in your shoes!)
- Instead of “I have to rest”, “I get to rest”
When things are truly not great
Whether due to internal or external factors, whether you can control something or not, sometimes things are truly not great. The trick here is that in most contexts, one can replace negative talk, with verbally positive talk, no matter how dripping with scathing irony. You’ll still get to express the idea you wanted, but your brain will feel more positive and you’ll be in a positive loop rather than a negative one.
This, by the way, is the inverse of talking to a dog with a tone of voice that is completely the opposite of the meaning of the words. Whereas the dog will interpret the tone only, your brain will interpret the words only.
- You just spilled your drink over yourself at a social function? “Aren’t I the very model of grace and charm?”
- You made a costly mistake in your business dealings? “I am such a genius”
- You just got a diagnosis of a terrible disease? “Well, this is fabulous”
None of these things involve burying your head in the sand, in the manner of toxic positivity. You’ll still learn from your business mistake and correct it as best you can, or take appropriate action regards the disease, for example.
You’ll just feel better while you do it, and not get caught into a negative spiral that ruins your day, or even your next few months.
Sympathetic/Somatic Therapy:
Lastly, an easy one, leveraging the body’s tendency to get in sync with things around us:
For when you do just need a mood change, have an uplifting playlist available at the touch of a button. It’s hard to be consumed with counterproductive feelings to the tune of “Walking on Sunshine”!
Bonus tip: consider having the playlist start with something that is lyrically negative while musically upbeat. That way, your brain won’t resist it as antithetical to your mood, and by the second track, you’ll already be on your way to a better mood.
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Codependent No More – by Melody Beattie
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.
This is a book review, not a book summary, but first let’s quickly cover a common misconception, because the word “codependent” gets misused a lot in popular parlance:
- What codependence isn’t: “we depend on each other and must do everything together”
- What codependence is:“person 1 has a dependency on a substance (or perhaps a behavior, such as gambling); person 2 is trying to look after person 1, and so has developed a secondary relationship with the substance/behavior. Person 2 is now said to be codependent, because it becomes all-consuming for them too, even if they’re not using the substance/behavior directly”
Funny how often it happens that the reality is more complex than the perception, isn’t it?
Melody Beattie unravels all this for us. We get a compassionate and insightful look at how we can look after ourselves, while looking after another. Perhaps most importantly: how and where to draw a line of what we can and cannot do/change for them.
Because when we love someone, of course we want to fight their battles with them, if not for them. But if we want to be their rock of strength, we can’t get lost in it too, and of course that hurts.
Beatty takes us through these ideas and more, for example:
- How to examine our own feelings even when it’s scary
- How to practice self-love and regain self-worth, while still caring for them
- How to stop being reactionary, step back, and act with purpose
If the book has any weak point, it’s that it repeatedly recommends 12-step programs, when in reality that’s just one option. But for those who wish to take another approach, this book does not require involvement in a 12-step program, so it’s not a barrier to usefulness.
Click here to check out Codependent No More and take care of yourself, too
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Aging Well: Exercise, Diet, Relationships
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
I am interested in the following: Aging, Exercise, Diet, Relationships, Purpose, Lowering Stress
You’re going to love our Psychology Sunday editions of 10almonds!
You may particularly like some of these:
- Seriously Useful Communication Skills! ← this is about relationship stuff
- Lower Your Cortisol! (Here’s Why & How) ← about “the stress hormone”
- How To Set Your Anxiety Aside ← these methods work for stress too
(This coming Psychology Sunday will have a feature specifically on stress, so do make sure to read that when it comes out!)
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Who Screens The Sunscreens?
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We Screen The Sunscreens!
Yesterday, we asked you what your sunscreen policy was, and got a spread of answers. Apparently this one was quite polarizing!
One subscriber who voted for “Sunscreen is essential to protect us against skin aging and cancer” wrote:
❝My mom died of complications from melanoma, so we are vigilant about sun and sunscreen. We are a family of campers and hikers and gardeners—outdoors in all seasons—and we never burn❞
Our condolences with regard to your mom! Life is so precious, and when something like that happens, it tends to stick with us. We’re glad you and your family are taking care of yourselves.
Of the subscribers who voted for “I put some on if I think I might otherwise get sunburned”, about half wrote to express uncertainties:
- uncertainty about how safe it is, and
- uncertainty about how helpful it is
…so we’re going to tackle those questions in a moment. But what of those who voted for “Sunscreen is full of harmful chemicals that can cause cancer”?
Of those, only one wrote a message, which was to say one has to be very careful of what is in the formula.
Let’s take a look, then…
Sunscreen is full of harmful chemicals that can cause cancer: True or False?
False—according to current best science. Research is ongoing!
There are four main chemicals (found in most sunscreens) that people tend to worry about:
- Abobenzone
- Oxybenzone
- Octocrylene
- Ecamsule
Now, these two sound like four brands of rocket fuel, but then, dihydrogen monoxide (DHMO), which is also found in most sunscreens, sounds like a deadly toxin too. That’s water, by the way.
But what of these four chemicals? Well, as we say, research is ongoing, but we found a study that measured all four, to see how much got into the blood, and what adverse effects, if any, this caused.
We’ll skip to their conclusion:
❝In this preliminary study involving healthy volunteers, application of 4 commercially available sunscreens under maximal use conditions resulted in plasma concentrations that exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens. The systemic absorption of sunscreen ingredients supports the need for further studies to determine the clinical significance of these findings. These results do not indicate that individuals should refrain from the use of sunscreen.❞
Now, “exceeded the threshold established by the FDA for potentially waiving some nonclinical toxicology studies for sunscreens” sounds alarming, so why did they close with the words “These results do not indicate that individuals should refrain from the use of sunscreen”?
Let’s skip back up to a line from the results:
❝The most common adverse event was rash, which developed in 1 participant with each sunscreen.❞
This was most probably due to the oxybenzone, which can cause allergic skin reactions in some people.
Let us take a moment to remember the most common adverse event that occurs from not wearing sunscreen: sunburn!
You can read the full study here:
None of those ingredients have been found to be carcinogenic, even at the maximal blood plasma concentrations studied, from applications 4x/day to 75% of the body.
UVA rays, on the other hand, are absolutely very much known to cause cancer, and the effect is cumulative.
Sunscreen is essential to protect us against skin aging and cancer: True or False?
True, unequivocally, unless we live indoors and/or otherwise never go about under sunlight.
“But our ancestors—” lived under the same sun we do, and either used sunscreen or got advanced skin aging and cancer.
Sunscreen of times past ranged from mud to mineral lotions, but it’s pretty much always existed. Even non-human animals that have skin and don’t have fur or feathers, tend to take mud-baths in sunny parts of the world.
If you’d like to avoid oxybenzone and other chemicals, though, you might have your reasons. Maybe you’re allergic, or maybe you read that it’s a potential endocrine disruptor with estrogen-like and anti-androgenic properties that you don’t want.
There are other options, to include physical blockers containing zinc and titanium dioxide, which are generally recognized as safe and effective ingredients.
If you’re interested, you can even make your own sunscreen that blocks both UVA and UVB rays (UVA is what causes skin cancer; UVB is “milder” and is what causes sunburn):
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