No Bad Parts – by Dr. Richard Schwartz

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We’ve previously reviewed Dr. Schwartz’s “You Are The One You’ve Been Waiting For” and whereas that book doesn’t require having read this one, this one would be an excellent place to start, as it focuses on perhaps the most important core issues of IFS therapy.

We all have different aspects that have developed within us for different reasons, and can generally “become as though a different person when…” and some condition that is met. Those are our “parts”, per IFS.

This book makes the case that even the worst of our parts arose for reasons, that they often looked after us when no other part could or would, and at the very least, they tried. Rather than arguing for “so, everything’s just great”, though, Dr. Schwartz talks the reader through making peace with those parts, and then, where appropriate, giving them the retirement they deserve—of if that’s not entirely practical, arranging for them to at least take a seat and wait until called on, rather than causing problems in areas of life to which they are not well-suited.

Throughout, there is a good balance of compassion and no-bullshit, both of which are really necessary in order to make this work.

Bottom line: if there are parts of you you’re not necessarily proud of, this book can help you to put them peacefully to rest.

Click here to check out No Bad Parts, and take care of yours!

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    Cut through the fluff with the standout book in a bloated series: The DASH Diet Mediterranean Solution, your best bet for heart-healthy living.

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  • Cashew Nuts vs Macadamia Nuts – Which is Healthier?

    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.

    Our Verdict

    When comparing cashews to macadamias, we picked the cashews.

    Why?

    In terms of macros, cashews have more than 2x the protein, while macadamias have nearly 2x the fat. The fats are mostly monounsaturated, so it’s still healthy in moderation, but still, we’re going to prize the protein over it and call this category a nominal win for cashews.

    When it comes to vitamins, things are fairly even; cashews have more of vitamins B5, B6, B9, and E, while macadamias have more of vitamins B1, B2, B3, and C.

    In the category of minerals, cashews take the clear lead; cashews have more copper, iron, magnesium, phosphorus, potassium, selenium, and zinc, while macadamias have more calcium and manganese.

    In short, enjoy both (as macadamias have their benefits too), but cashews win in total nutrient density.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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  • Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response

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    BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.

    Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.

    Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”

    As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.

    Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.

    The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.

    Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.

    But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.

    Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.

    Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.

    “If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”

    From Pioneer to Lagger

    California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.

    The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.

    Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.

    In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.

    When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.

    Fall From Grace

    Morrow’s troubles started long after the original California program had been shut down.

    The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.

    But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.

    The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.

    Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”

    By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”

    Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.

    “I didn’t have to feel naked and judged,” she said.

    Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.

    Physician Privacy vs. Patient Protection

    The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.

    Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.

    Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.

    Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.

    “To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.

    Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.

    The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.

    People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.

    “The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.

    The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.

    Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.

    “I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    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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  • The Pain-Free Mindset – by Dr. Deepak Ravindran

    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.

    First: please ignore the terrible title. This is not the medical equivalent of “think and grow rich”. A better title would have been something like “The Pain-Free Plan”.

    Attentive subscribers may notice that this author was our featured expert yesterday, so you can learn about his “seven steps” described in our article there, without us repeating that in our review here.

    This book’s greatest strength is also potentially its greatest weakness, depending on the reader: it contains a lot of detailed medical information.

    This is good or bad depending on whether you like lots of detailed medical information. Dr. Ravindran doesn’t assume prior knowledge, so everything is explained as we go. However, this means that after his well-referenced clinical explanations, high quality medical diagrams, etc, you may come out of this book feeling like you’ve just done a semester at medical school.

    Knowledge is power, though, so understanding the underlying processes of pain and pain management really does help the reader become a more informed expert on your own pain—and options for reducing that pain.

    Bottom line: this, disguised by its cover as a “think healing thoughts” book, is actually a science-centric, information-dense, well-sourced, comprehensive guide to pain management from one of the leading lights in the field.

    Click here to check out The Pain-Free Mindset, and manage yours more comfortably!

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Related Posts

  • Live Life in Crescendo – by Stephen Covey and Cynthia Covey-Haller
  • Cannabis & Heart Attacks

    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.

    For many, cannabis use has taken the place that alcohol used to have when it comes to wanting a “downer”, that is to say, a drug that relaxes us as opposed to stimulating us.

    Indeed, it is generally considered safer than alcohol ← however this is not a strong claim, because alcohol is much more dangerous than one would think given its ubiquity and (in many places, at least) social acceptability.

    We’ve talked a bit about cannabis use before, in its various forms, for example:

    Cannabis Myths vs Reality ← a very good starting point for the curious

    And one specifically about the use of THC gummies (THC is the psychoactive compound in cannabis, i.e. it’s the chemical that gets people high, as opposed to CBD, which is not psychoactive) as a sleep aid:

    Sweet Dreams Are Made of THC (Or Are They?)

    And for those skipping the THC, we’ve also written about CBD use, including:

    CBD Oil: What Does The Science Say? and Do CBD Gummies Work?

    So, about cannabis and heart attacks

    Alcohol is a relaxant, and yet it can contribute to heart disease (amongst many other things, of course):

    Can We Drink To Good Health? ← this is mostly about red wine’s putative heart health benefits, how the idea got popularized, and how it doesn’t stand up to scrutiny when actually looking at the evidence.

    And cannabis, another relaxant? Not so good either!

    New research has shown that cannabis users have a higher risk of heart attacks, even among younger and otherwise healthy individuals. This is based on analyzing data from 4,636,628 relatively healthy adults.

    Specifically, the data showed that even young healthy cannabis users get:

    • Sixfold increased risk of heart attack
    • Fourfold increased risk of ischemic stroke
    • Threefold increased risk of cardiovascular death, heart attack, or stroke

    We mention the otherwise “relatively healthy” nature of the participants, because it’s important to note that less healthy people (who were perhaps using cannabis to self-medicate for some serious condition) were not included in the dataset, as it’d skew the data unhelpfully and it’d make the risk look a lot higher than the risk levels we mentioned above.

    The mechanisms by which cannabis affects heart health are not fully understood, but hypotheses include:

    • Disrupting heart rhythm regulation
    • Increasing oxygen demand in the heart muscle
    • Causing endothelial dysfunction, which affects blood vessel function

    Further, heart attack risk peaked one hour after cannabis use, and while this doesn’t prove causality, it certainly doesn’t make cannabis look safe.

    You can read the paper in its entirety here:

    Myocardial Infarction and Cardiovascular Risks Associated with Cannabis Use: A Multicenter Retrospective Study

    Want a safer way to relax?

    We recommend:

    Enjoy!

    Don’t Forget…

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  • Pine Nuts vs Macadamia Nuts – Which is Healthier?

    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.

    Our Verdict

    When comparing pine nuts to macadamias, we picked the pine nuts.

    Why?

    In terms of macros, it’s subjective depending on what you want to prioritize; the two nuts are equal in carbs, but pine nuts have more protein and macadamias have more fiber. We’d generally prioritize the fiber, which so far would give macadamias a win in this category, but if you prefer the protein, then consider it pine nuts. Next, we must consider fats; macadamias have slightly more fat, and of which, proportionally more saturated fat, resulting in 3x the total saturated fat compared to pine nuts, gram for gram. With this in mind, we consider this category a tie or a marginal nominal win for pine nuts.

    In the category of vitamins, pine nuts have more of vitamins A, B2, B3, B9, E, K, and choline, while macadamias have more of vitamins B1, B5, B6, and C. A clear win for pine nuts this time, especially with pine nuts having more than 17x the vitamin E of macadamias.

    When it comes to minerals, pine nuts have more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while macadamias have more calcium and selenium. Another easy win for pine nuts.

    In short, enjoy either or both (diversity is good), but pine nuts are the healthier by most metrics.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Enjoy!

    Don’t Forget…

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  • What Nobody Teaches You About Strengthening Your Knees

    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.

    Strengthening unhappy knees can seem difficult, because many obvious exercises like squats may hurt, and can feel like they are doing harm (and if your knees are bad enough, maybe they are; it depends on many factors). Here’s a way to improve things:

    The muscle nobody talks about

    Well, not nobody. But, it’s a muscle that’s rarely talked about; namely, the tibialis anterior.

    It plays a key role in decelerating knee motion—in other words, the movement that hurts if you have bad knees. It’s essential for absorbing shock during activities like walking, climbing stairs, and stepping off curbs

    So, of course, strengthening this muscle supports knee health.

    The exercise this video recommends for strengthening it involves leaning against a wall with feet about a foot away (closer feet make it easier, further makes it harder). Note, this is a lean, not a “Roman chair”.

    The exercise involves squeezing the quadriceps, lifting toes toward the nose, and engaging the tibialis anterior muscle. If you’re wondering what to do with your hands, they can be held out with palms open to work on posture, or hanging by the sides. Do this for about 1½–2 minutes.

    For more on all this, plus a visual demonstration, enjoy:

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

    Want to learn more?

    You might also like to read:

    When Bad Joints Stop You From Exercising (5 Things To Change)

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

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