A COVID-19 STORY

Offered by Genevie Kocourek, M.D.

 

The Essence of Ritual 

Rumi

Pray the prayer that is the essence

of any ritual.  God, I have no hope, 

I am torn to shreds.  You are my first, 

my last and only refuge.

Do not do daily prayers like a bird

pecking its head up and down.

Prayer is an egg.  Hatch out 

the total helplessness inside.

 

One of the most startling aspects of the COVID-19 pandemic is the ability it has had to polarize people.  We are vilified for not wearing a mask; we are vilified for wearing a mask.  We believe it is a manmade, malicious-intent virus or we believe it is a natural, particularly virulent pathogen.  Regardless of where you stand, it is important to hold compassion for those who are hit hard by the virus.  It not only affects those with prior conditions but also those who follow a very clean, organic, healthy lifestyle and have no comorbidities.  I invite you to enter into the experience of one such patient.  Her story is a narrative between herself and one of her physicians, me.

When patients are hit hard by the virus, there often are three phases.  The first phase is a set of symptoms that we now know are quite variable and typically include a few days of fever.  The second phase is very serious with fever and severe symptoms of burning lungs, exhaustion, and weakness.  The third phase is extremely variable in its symptoms, with a duration that is still unknown.  This patient’s story begins in the third phase.

I believe there is a tremendous amount of shaming and blaming going on collectively right now towards people who (in the past) had no voice/no seen presence, because they were of a certain economic stature, or race or age or health.  I used to think I was above all that, but I feel it everywhere now, including in myself.

I don’t know why I am feeling scared, but I am.  I feel like I’m starting all over again. I know you referred to this as the third wave. I’m hoping it won’t be like the storm of the second wave.  It’s interesting, this harsh reality of needing to surrender into the unknown and learn how to wait and sit with the fear of the unknown.  It is foremost in my mind because there is no plan and nothing I can do but ride out the illness.

I feel like I’m sinking under the surface of the ocean. I know it’s not true, but I feel like I’ll never rise to the surface again.  It must be how people feel when they are dealing with hypothermia—like it’s okay to fall asleep and never wake up again.  It’s a horrible feeling.  I normally consider myself such a fighter and one who perseveres.  These feelings are new to me.

I’ve been on an epic journey where my body had to fight for its life and it’s not over yet. I am still dealing with several symptoms and recovery is very slow.  People have asked, “Where did you get it?”  There is no answer to this.  The virus is airborne and it’s now everywhere.  It’s not like you or I just stepped into it.

People also hold the misperception that this just affects your lungs. Not so. Over a month ago I began to experience symptoms that came on gradually.  If you’re interested, here goes:

SLEEP DISRUPTION.  One night four hours, the next nine hours, then back to three hours.  FATIGUE that eventually becomes debilitating.  DIZZINESS like your head is one big fishbowl with water sloshing from side to side tsunami fashion.  LUNGS similar to an episode of life-threatening pneumonia I suffered from in the past but with more burning and desperate air-hunger.  I imagine dying of emphysema would be similar.  

PERICARDIUM feels so squeezed by enlarged lungs pushing on it, it feels as if you are having a heart attack.  HANDS AND FEET.  Your fingers and toes become stiff and will feel like they are in ice water.  They may have small blood clots.  NEUROPATHY in numerous locations of the body.  Every nerve feels like it’s on fire, especially in the extremities.  HEADACHES with pressure beyond ten migraines experienced at the same time.  It comes from encephalitis.  The brain is literally enlarged/swollen.  MEMORY.  You will not be able to remember the most basic of thoughts. This finally forced me to reach out to others saying, “This is really hard.”  PAIN so severe you’ll feel like you’re losing your mind while simultaneously suffering under the other symptoms.  MUSCLE TONE is out the window.  You stand up and your legs give out from under you like Bambi on the ice.  At this point, you’re wondering what parts of your body if any, you can rely on.  FEVER/CHILLS are intermittent and unpredictable.  DEHYDRATION becomes a serious issue. You’re burning through sodium and other minerals very quickly.  Every hour, I would pour salt into my hand and lick it, then sip an entire glass of water.  Gatorade, rehydration and electrolyte formulas could not keep up with the dehydration.  I did not realize this until I became semi-comatose and my neighbor found me.  INTESTINAL changes—you can use your imagination.  ADRENAL FATIGUE because your adrenals will be completely spent of energy just to keep you alive.  BLOOD CLOTS are always a hidden potential, especially during prolonged periods of lying down.

I am still experiencing some of these symptoms and recovery will be protracted.  We live in a culture that likes stories with well-defined beginnings, middles and endings, but this illness does not provide that.  The beginning doesn’t start with, “I was being very careful and isolated, and I still got COVID.”  The middle doesn’t continue with, “I did all the right things.”  The ending doesn’t come with, “and now I’m all better.”  The daily question of, “Are you doing better?” can become exhausting because you want to but cannot respond with, “Yes.”  

The whole process of recovery is ambiguous and unpredictable and requires a complete surrender to allowing things to unfold as they will without imposing our expectations on our bodies beyond the desire of wanting to get well again.  It’s scary and yet I stay on the path of recovery knowing I’m not alone (in spite of living alone) as I am supported by others in prayer, good wishes and love.  I have two amazing doctors working with me providing medical advice and guidance.  Except during the storm of experiencing the worst symptoms, I was able to remain in prayer and meditation while mindfully and slowly breathing.  

Whew!  It’s a journey.  An epic journey.  And my journey is not over yet.  I trust that one day it will be.  I didn’t want to “bother anyone” with what was and is still happening to me, but there is a part of me that forced me to speak up—my will to survive.  Suffering from COVID is real and we cannot continue to do it behind closed doors. It doesn’t matter if we are suffering in our hearts, minds or bodies.  

We need one another and COVID has given each of us the opportunity to extend compassion and outreach to assist others, no matter who they are or what their need.  We are wired to care and serve.  Life is rather empty otherwise.  Please take this pandemic seriously.  I am one of the lucky ones not to have died.  Through this pandemic, we are learning that in the long run, only love matters.

©September 2020 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. During the COVID pandemic she is meeting symptom-free patients in-person and offering care via telephonic appointments.  Call our office to schedule at 262.695.5311.

 

A Healer’s Perspective on the Uncertainty of COVID-19

UNCERTAINTY

We try to prepare for uncertainty

But the only certainty we have

Is that we are held, intimately held,

By the certainty which created the uncertainty.

So that by releasing ourselves into the uncertain,

We can discover the certain,

Which has carried us all along.

Kathryn Song, ©03/13/2020

In this time of the COVID-19 pandemic, physicians are wrestling with how to provide the best care for their patients. While we as physicians and practitioners are doing all that we can for our patients at present both in-clinic and remotely, there are limitations.  Dr. Kocourek recently reached out to Patrick Rodriguez, one of her energy healers to discuss the impact on personal energy from the COVID-19 pandemic. She asked him to discuss his perspective on dealing with the uncertainty that’s going on right now—all the unknowns. The following is his response of March 22, 2020.

Carl Jung, a famous philosopher and psychoanalyst, is credited with defining the concept of the ‘collective unconscious.’  He said that, yes, we live our lives through our own eyes, our own consciousness, but we all also share an unconscious awareness. We are going through a time right now when the collective unconscious is that of fear, panic, anxiety, but also anger. The collective unconscious really IS all of us.  

At times it seems rather esoteric. It happens to a great extent on the local level and an even greater extent on the national level. In the United States, we have a media that is wonderful as far as information goes. We have over one-hundred channels available twenty-hours a day, and yet the predominance of current programming focuses on COVID-19. That flows into the collective unconscious. Even if you turn off the television, even if you don’t engage in social media, it’s now come to the point where it’s so strong, ALL of us are being affected.

In March, the Governor of California stated that he expects up to 50% of the population of California to contract COVID-19.  I’m of the opinion from what I’m feeling and from people with whom I am speaking—and this is just a wild guess, that 70% of the population has already contracted the SIDE EFFECTS of the virus of fear, worry, anxiety, panic, and anger.

It’s especially difficult for those who can feel the feelings of others. This happens very, very subtly, and this is where the real problem lies. Something that is a normal occurrence in a person’s life, and which would anger them to some level has changed in magnitude. Let’s look at anger as an example. If a person’s reaction would normally be at a level of 3 on a scale of 0 to 10, but they unexpectedly find themselves at a level of 8, then what they’re not consciously aware of is they are also tied-in to the collective unconscious.

That’s when it’s very useful to be aware: “This isn’t me. This ISN’T me.”  The term for people who can feel the feelings of other people is ‘empath.’  These are people who can consciously feel the feelings of other people. The feelings of fear, anxiety, worry, and panic are so strong in our collective at this time. My belief is that all of us are feeling it, whether we are aware of it or not. What I teach people who do have empathic abilities, is how to manage it. For those of us who are empaths, we’re often bombarded with feelings that we don’t understand and think they’re our OWN feelings. Even our own physical hurts, such as feeling back pain or knee pain, or all kinds of interesting things going on in our bodies it is, “Wow, I have a pain in my knee, and I’ve never had that before. I don’t remember hurting my knee.”

What I have people do is focus on the feelings. Allow the feelings to be there. Don’t try to push them away; don’t take ibuprofen immediately.  Firstly, focus on them. It can be knee pains, it can be anger. It can be anything that you’re feeling.  Secondly, ask the question as if you are expecting an answer: “Who does this belong to?” Now, who are you asking?  It doesn’t really matter. If you believe in God, ask the question of God, or ask another spiritual deity or power, or your own subconscious mind—it doesn’t really matter.  What does matter is asking with congruity. Ask the question with every part of your being engaged and expect an answer. Now, the concept is that the answer doesn’t matter.  We don’t care about the answer; we care about the question—the ENERGY of the question.  In other words, put EVERYTHING you have into it and ask: “Who does this belong to?”  If it’s a feeling of worry ask, “Who does this worry belong to?”

The first time you ask this question, you may feel rather silly.  Join the club! The feeling of silliness is an emotion usually triggered by our own internal energies.  You already may feel worried about something. You already may feel panic that, “Oh my god, I don’t have enough toilet paper!”  It’s the exponential increase of the worry that you’re trying to reduce. “Who does this belong to?” “Who do these feelings of worry, panic, anger, etc., belong to?”  Allow the feelings to come up. Ask the question, EXPECTING an answer. Take a deep breath and ask again, “Who do these feelings belong to?”

Almost every person I have worked with using this approach has immediately felt a drop in the level of their emotional intensity.  You may not notice much after the first round, but if you do it again, then again, each time with intensity of intention saying, “Who do these feelings belong to?”  The next thing you know is, “I do need to buy some toilet paper, but it can wait until next week.”

We’re living in an unprecedented time. In past disasters that have befallen the nation and the world, we have had to wait for the morning newspaper or the evening news, when we had very few stations. There is now 24-hour coverage. That can be in our favor, but for many of us, it’s not. Do you need to avoid the constant blitz of the media? That’s a question that can be interpreted in many ways. Some will feel they cannot turn off the media because they have a great need to be informed, and that’s okay.  This energy is ALREADY in the collective unconscious and it’s a matter of becoming aware of YOURSELF as part of the collective.

This does not have as much to do with listening to the media as it does with becoming AWARE of your own feelings.  If you do choose to stay connected, do so with a measure of discernment.  Keep in mind that newspapers, news programs, and the media sell advertising.  They often use sensationalism. That’s not to imply that they aren’t reporting true stories, it’s that they do so with a measure of sensationalism—to capture the interest of the reader, the viewer.  I’m not saying to turn it all off and go into isolation or be a hermit, but use discernment when watching, when reading. Mostly, it is in those times when it SEEMS like it is completely unrelated that you suddenly feel you need a gallon of milk, and THEN you feel panic.

A special note for empaths:  Even those of us who are familiar with the impact of energies can be affected or caught off-guard. As an empath, I found myself buying several hundred dollars of food this past week. In and of itself, that was rather extreme, but then add the fact I had been shopping two days before.  It wasn’t until I was at the register and saw the total bill that I realized, “Oh, these feelings aren’t mine!” Yes, it was a little late in the game! Those are the times we need to remind ourselves, we are a part of the collective and need to be compassionate with ourselves.  Try to find joy, which can be a little rough these days. The more joy you have, the stronger your immune system will be. It doesn’t mean you will be protected from every virus or won’t contract an illness, but whatever level your immune system was at, it will increase to a degree and be stronger.  © 03/22/2020  

Dr. Kocourek wishes to express her gratitude to Patrick Rodriguez for sharing his perspective and experience.  She hopes her readers find it helpful in navigating the COVID-19 situation.

Dr. Kocourek also wishes to remind our Ommani community that in addition to herself, during this time our services continue to be available to you, including those offered by Dr. Kumar, internal medicine; Eric Ehrke, psychotherapy; David Johnson, homeopathy; Shelley Carpenter, physical therapy, Reiki and yoga; Aimee Brown, acupuncture; and Tammy Winkelman, massage and craniosacral therapy. Telephonic or Skype appointments can be scheduled. In-person appointments can be scheduled when medically appropriate. Reach out to us at 262.695.5311.

©April 2020 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. During the COVID Pandemic she is meeting patient needs with care via telephonic appointments.  Call our office to schedule at 262.695.5311.

Return to Nepal – A Journey of Gratitude

Some of you may recall that I and two others traveled to Nepal last year to serve in a health post in a remote village. Because of an April 2015, 7.8 magnitude earthquake areas of the city are still under reconstruction and remote areas near Kathmandu are still in much need of service and renovation. The Mount Everest Foundation for Sustainable Development was once again our sponsoring organization. My service teammates and friends were Cindy Jones, an RN from the greater Milwaukee area, and Juan Pablo Murphy, an engineer from South Carolina. The program’s goal is to serve the health needs of remote villages that cannot be accessed by vehicles and create sustainability by helping to teach the local nurses in those villages.

After approximately 30 hours of travel time, Cindy, Juan Pablo and I arrived in Kathmandu and settled into our hotel. We met Mr. Deha Shrestha, CEO of Everest Parivar Expeditions Pvt., Ltd., who was our coordinator for the trek itinerary and who helped with scheduling our post-trek site-seeing. The next day we met Nawang Sherpa, a seasoned Sherpa, who served as our trekking and expedition logistics coordinator, and his daughter, Nima Sherpa, who served as our interpreter.

We were treated with exceptional weather and were able to see Kathmandu and the villages without the heavy mists that we encountered last year. Our Sherpa cook was Dorje. He was our cook last year, so we were tickled to see him again. He is an incredibly gentle but tough man. His job was to feed us, but he made art out of his food presentations.

Following an eleven-hour jeep ride, we arrived in the village of Jhapre in the early afternoon and checked into our “5-star hotel,” a wooden structure with simple rooms that had benches for our sleeping bags. It was “5-star” because the toilet (non-flushing) was indoors!

On our trek to the health post, the next day, our Sherpa guide was so very caring. He took us on a route that climbed to 11,000 feet. We were huffing and puffing from the effects of the altitude, but were absolutely amazed at the beauty of the mountain ranges (Annapurna and Himalayan) that his route had made possible for us to see-the mountains do not appear to be real; they are so very majestic. After hiking the full day to Patale, we settled into our rustic rooms at the health post. No indoor toilet or running water here! We cared for approximately 60 patients during our two clinic days this year, down from 110 last year. We think this was due to the Tihar festival that was underway in the country.

After our two days at the health post, we hiked back to Jhapre, ate a lovely Sherpa meal, then rested. The following day we said good-bye to our Sherpa team and began the two-leg jeep ride back to Kathmandu. We traveled the first leg by a special jeep that was able to navigate the road that was still in very rough shape from the monsoons. It took an hour to travel the seven-kilometer stretch! We ate breakfast at a roadside restaurant, then began the thirteen-hour ride back to Kathmandu.

After our clinic days were complete, Mr. Pranoj Rajkarnikar, a local businessman who was our in-country liaison in 2018, served as our translator and personal guide in Nepal. We visited tourist and non-tourist areas in Kathmandu, Pokhara and Lumbini. Some of our activities were visiting the Avant Garde school, paragliding with mountains on the horizon, visiting numerous temples and Buddha historical sites, sharing tea with Pranoj’s family and friends of his family, attending Newari festivals in the evening, and driving through less-traveled areas with our gracious taxi drivers.

All three of us believe our second journey was as great a success as our first. We are again exceedingly grateful to have had the opportunity to provide medical care to the people of Patale and its surrounding villages. We are ever-reminded of what we have in this country – financial resources, indoor plumbing, electricity that is reliable, internet service that is up more than it is down, roadways that are passable and garbage control.

Because of our personal guide, Pranoj, we learned much more about the country and were able to share fellowship with farm families, Sherpa families, and the children of the Avant Garde school. We are always deeply touched by the gentleness and hospitality of the people we met or served, and those who took such good care of us – our coordinator, Deha; our interpreter, Nima; our Sherpa leader, Nawang; our Sherpa cook, Korje; and our personal friend and guide, Pranoj, and the others who comprised our Sherpa team. Without this, the journey would not have been possible.

Please enjoy the photographs we took along the way.

December 2019 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family. Schedule an appointment by calling 262.695.5311

We All are Broken, We All are Whole

Were you the one

In puzzling quiet

Left to cry in sodden diaper 

Now become the frequent liar?

 

We all are broken,

We all are whole.

 

Were you the one called good li’l girl

When hands in wrongness

Probed your secrets,

Who buried deeply all the sorrow.

Locked in bitterness and shame

Now become the one who blames?

 

We all are broken,

We all are whole.

 

Were you the one

In lonely silence,

Who turned to spirits,

Drugs or lovers,

Now become the one who smothers?

 

We all are broken,

We all are whole.

 

Were you the one

By sibling bested

Who ever, always, feels unrested

Who seeks affection, love, acceptance,

But from yourself is always absent

Now become the one who pageants?

We all are broken,

We all are whole.

 

Were you the one

Whose loved one left

With promises made but never kept

Who held your vigil

And checked your tongue

Now become the one who shuns?

 

We all are broken,

We all are whole.

 

Were you the one

Whose dreams were grand

Who quickly learned

The visions at hand

Would not be gained with wedding band

With bitterness and fueling ire

Now become one with words of fire?

 

We all are broken,

We all are whole.

 

Are you the one

Who weeps within

From grief and pain

That still you hold

Within these words

Are yet untold

Who knows the sorrow and the loss 

Yet blocks the fear at any cost?

 

We all are broken,

We all are whole.

 

The days pass swiftly

The seasons fly

We listen, we learn, we live

And in the process

We choose to forgive.

 

Are you the one

Who now can see

A path of newness 

In your forest of trees

Within your spirit holding space

And finding for self a welcome place?

 

We all are broken,

We all are whole.

 

Are you the one

Who knows your needs

Accepts your limits,

Releases your victim

Within you tenderly holding sorrows

Recognizing there are bright tomorrows?

 

We all are broken,

We all are whole.

 

Are you the one

Who knowing your patterns

Steps aside and chooses that which matters

Who now can love

Embracing all others,

Releasing your grudges

Quelling the judgments?

 

We all are broken,

We all are whole.

 

Are you the one

With new discovery

Is gifting others

Yet ne’r depleted

Aware with knowledge

Your life creating,

In thought, in action, 

Minute by minute?

 

We all are broken,

We all are whole.

 

Are you the one

With visions clear

Seeing now there’s naught to fear

Trading miserly, cowardly rage

For colossal, heartfelt, boundless courage

Building purposely

Action by action

A life of joyous satisfaction?

 

We all are broken,

We all are whole!



Gen Kocourek

16 June 2014

Sleep and Health

One of the most common complaints that health providers hear is: “I can’t sleep.”  About 40 million American adults will report an issue with sleep during the past year, about 30 million have sleep apnea (intermittent breathing cessation during sleep), and 25 million have sleep issues from shift work.  Poor sleep can lead to excessive daytime sleepiness (EDS). This, in turn, can lead to accidents and disasters, and health ramifications because we are often totally unaware of how our capabilities are reduced—we have become so habituated to a low level of alertness.  Sleep quality and length is a stronger predictor of mortality than tobacco use, high blood pressure, or obesity, and affects our physical and mental stamina as we age. REM sleep and dreaming are beneficial for memory, learning, emotional healing, raising our pain threshold, and expanding consciousness (like a natural physiological yoga, so to speak).

Chronic insomnia is a strong predictor of depression, and depression is often an indicator that poor sleep is in play.  Some believe that the fatigue that comes with depression is simply the body’s exquisite mechanism to force rest. Sleep issues can lead to or exacerbate many conditions including reduced resistance to viral infections, obesity, diabetes, cardiovascular disease, cancer and/or chronic inflammation and pain.

In the purest sense, sleep is a “letting go of being awake,” rather than making ourselves sleep.  We cannot intentionally will ourselves to sleep—in fact, attempting to do so will make it worse.

Sleep issues (insomnia, dyssomnia) are typically categorized as difficulty falling asleep, difficulty staying asleep, or non-restful sleep (waking unrefreshed).  If you are having issues with sleep, consider and experiment with the following to see if your sleep quality and/or quantity improve:

  • Caffeine:  This substance can disrupt sleep even if only 8 oz is consumed in the morning.  Avoid caffeine, even in small amounts such as chocolate or tea.
  • Alcohol:  Many believe that alcohol helps them sleep.  In fact, it can induce drowsiness and speed the falling-asleep process.  Unfortunately, the sleep that follows is ragged and not restful. Alcohol also suppresses melatonin resulting in frequent awakening.  Avoid alcohol as a regularly consumed beverage, and save it for special occasions if you are not able to completely abstain.
  • Sugary foods and snacks:  Foods with a high insulin-index or high glycemic-index can disrupt sleep by engaging our “awake” metabolism, rather than our “sleep” metabolism.  Avoid these foods within 3-4 hours of sleep. If you must have a sweet snack, eat it earlier in the day to allow your body to fully metabolize it.
  • Exercise:  While exercise is exceptionally helpful when done early in the day, when done within 3-4 hours of sleep, it can have a negative impact on sleep.  Rise and shine!
  • Breathing:  If you snore or someone tells you that you stop breathing while you sleep, discuss the possibility of sleep apnea with your physician.
  • Keep a regular rhythm:  Work to retire at about the same time each evening, and awaken at about the same time each morning.
  • Modify your environment:  Keep the bedroom cool (68 degrees F), completely dark.  
  • Learn your mode of optimal sleeping by experimenting with each of the following for a minimum of two weeks:  1) Lie down in bed BEFORE you feel your energy is totally exhausted, even an hour prior, and engage in any activity that allows your body to unwind and release energies from the day that do not belong to you.  2) Allow your energy to become completely exhausted before you drop into bed. Complete your bedtime routine ahead of time, so that when you are exhausted there is nothing else you need to do other than “drop into bed.”  3) Get into bed before your energy is exhausted, and work, read or watch television until you feel your energy is exhausted. 4) Get into bed before your energy is exhausted and release the energies of the day that are not yours.  Do this by engaging in peaceful, unwinding activities such as reading a relaxing book or listening to calming music until you feel your energy release.
  • Rhythms:  Our planet is becoming increasingly brighter day-by-day.  Exposure to bright light beyond normal circadian rhythms can be particularly disruptive.  This includes exposure to smart devices. Avoid exposure to smart devices the hour before sleep.  If you must access these devices, set them to “night mode.” There are also glasses that can be purchased to eliminate the retina-activating blue light of smart devices that do not offer night mode.  Menstrual cycle rhythms can disrupt sleep—keeping a diary of how sleep changes during your cycle can help you identify when you may need more or less sleep.
  • Shift work:  As much as you are able, keep to a consistent sleep schedule.
  • Behaviors:  Do not watch the clock if you find yourself in wakefulness.  Avoid “post-dramatic stress disorder” by not watching action-filled television shows prior to bedtime.  Avoid excessive web-surfing the hour prior to bedtime. Keep electronic devices two arms-lengths from your body.  Do not sleep with a device in your bed or on your person, including a Fitbit type of device on your wrist, remembering that pacemakers and medical devices are excluded!  If you awaken with the racing thoughts of your “monkey mind,” take a moment to write down a few of your racing thoughts, make note of any dream you are having, or make note of something you need to do in the morning.  “Monkey-mind” is extremely common and needs to be tamed with practice. You can use this phrase: “Monkey-mind, get in the back seat, you are not driving right now.” Avoid engaging in stimulating conversations or arguments prior to bedtime.  Develop a “safe-phrase” such as “this is an important matter to me/you/us, but it doesn’t work for me to discuss this so close to bedtime. How would it be if we planned a time to discuss this tomorrow/next week/etc.?”
  • Individual space:  Try sleeping alone.  For many, sleeping alone can be very beneficial.  If your partner moves a lot during sleep, it can be very disruptive to you and make the sleep situation feel unsafe while you sleep.  Also, the energy of your partner can “leak” onto you—if they are having vivid dreams, for example, your sleep can also be disrupted. If your partner snores, this can be exceptionally disruptive.  Initially, sleeping alone can feel very odd, or even lonely, but given time, you will likely find your sleep to be more restful.
  • Pain:  If chronic pain keeps you awake, discuss this with your provider or see a Pain Specialist.
  • Recreational drugs:  Depending on the particular substance involved, your sleep can be disrupted in any or all of the three insomnia categories.
  • Sleep aids:  Avoid starting any pharmaceutical sleep aids, or use them for only critical issues and for very short periods of time.  Sleep medications and benzodiazepines are extremely dependence-forming, and while they may help you fall asleep, the sleep they provide is NOT the same.  Benadryl (diphenhydramine) can be used without forming physical dependence, but emotional dependence can occur.
  • Napping:  Once considered an essential component of the daily routine (and still so in some countries), we have moved away from napping in favor of working even more hours, and increasing our stress levels.  Naps have been shown to lower blood pressure, regulate emotions, and improve task performance. The ideal nap is 20 minutes in the middle of the day.
  • Try various natural remedies:  lavender on a cotton ball near your pillow, valerian root, Rescue Remedy, Perelandra ERS, calming caffeine-free teas, melatonin (low doses often work best); breathing exercises.

We are defenseless when we sleep.  If you do not feel safe in life, you will not feel safe in sleep.  See a psychotherapist to identify emotional or behavioral issues that may be keeping you from falling asleep, or returning to sleep if you awaken.

You can still obtain rest, even if you are not fully asleep.  If you find yourself lying awake, say to yourself “I may not be asleep, but I am still getting rest.”  Allow yourself to surrender to sleep.

References:

©Jun 2019 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.

Protein Alternatives

When we consider a healthy diet, we tend to be obsessed with protein.  Those of us who listen to our doctors here at Ommani are learning that a plant-based diet is optimal for good health. So a new year is upon us and we’re ready to make the transition, not necessarily to become vegetarian but to make plants the basis of our diet.  What’s a healthy plant-based, protein substitute that tastes good and is an important building block of bones, muscles, cartilage, skin, and blood while providing the wide variety of nutrients so many of us expect from the meat we eat? I’m not talking about the most common protein substitute, tofu—I’m talking about nuts.

According to an article by Jamie Ducharme in the January 28, 2019 issue of Time Magazine, swapping beef for protein-rich plants like beans, peas, and nuts has big health benefits (turns out, both for us and the planet).  With regard to nuts, benefits vary by nut, but they all have protein, healthy fats, vitamins, and minerals. In general, nut consumption is linked to lower rates of Type 2 diabetes, healthier cholesterol and triglyceride levels, smaller waist circumference, better blood pressure levels, and less insulin resistance.

A Food & Dining, JournalSentinel article by Jill Weisenberger dated January 23, 2019, and the US Dept of Agriculture Nutrient Data Lab provides basic information about five of the most common types of nuts:

  • Almonds:  Ten almonds provide 2.5 grams of protein.  Almonds are very beneficial for the heart; lower bad cholesterol and appear to improve good cholesterol.
  • Peanuts:  Remember they are not truly nuts—they are legumes.  A handful of peanuts provides 7 grams of protein. Peanuts are affordable and at least half of the fat in peanuts is heart-healthy monounsaturated fat, the kind found in olive oil and avocados. And over 30% is polyunsaturated fat; another good fat that is important in a healthy diet.
  • Pecans and walnuts:  The pecan is the only tree nut indigenous to America. An ounce of walnuts contains slightly more protein than an ounce of pecans – 4.3 vs 2.69 grams of protein.  Both nuts contain a high amount of fiber and have trace minerals manganese and copper, minerals important for brain and nervous system function. Studies have shown both nuts to be helpful for improved insulin sensitivity and reduction of Type 2 diabetes. The phytonutrients in pecans and walnuts can also help with general gut biome health.
  • Pistachios:  Nuts are generally high in calories, but these nuts are the lowest; weighing in at 156 calories per ounce and containing 6 grams of protein. They are also high in antioxidants and one of the most vitamin B6-rich foods.  Vitamin B6 is important for several bodily functions especially blood sugar regulation.

The World Economic Forum has much to say about nuts as the best protein alternative to help reduce carbon dioxide emissions because they release virtually none – not true of animal-based proteins.  So, add nuts to your diet and reduce your meat consumption – your body and the planet will love you for it.

References:

https://healtheating.sfgate.com/much-protein-there-10-almonds-6030.html

https://www.healthline.com/nutrition/9-benefits-of-pistachios

www.peanut-institute.org

https://www.nal.usda.gov/fnic/usda-nutrient-data-laboratory

https://www.pressreader.com/usa/milwaukee-journal-sentinel/20190123/page/10/textview

 

February 2019 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.  Schedule an appointment by calling 262.695.5311

Your Immune System – Taking A Moment To Marvel

Recently, I had the opportunity to experience the remarkable actions of my immune system.  Having been “gifted” by one of my patients with a rousing upper respiratory infection, I was reminded of the many mechanisms of the body that work to keep me healthy.  I saw this patient again after we had both recovered, and we laughed together and shared that it was wonderful that neither of us would likely be affected by this virus in the future.  That is because of the marvelous mechanisms of our immune systems.

Our immune system is designed to protect us from harmful bacteria, microbes, viruses, toxic substances, parasites, and helminths (worms).  Without our immune system, we would be invaded by numerous organisms that would break us down cell by cell and leave us as a skeleton. Eventually, the bones themselves would be broken down, too.

Our immune systems never sleep and are mind-boggling in their complexity.  Two full-semester courses are dedicated to the immune system during medical school.  During the first semester, medical students learn about the normal workings of the immune system mechanisms (fever, hives, inflammation, infections, antibodies, vaccinations, etc.) and the second semester, they learn about how it goes awry.  Despite this intensive study, there are many aspects of the immune system that we have yet to understand and, hopefully, eventually harness for our greatest good.

The skin is your first defense.  It consists of multiple layers that protect against the invasion of bacteria and other pathogens. Its job is to recognize invaders and close off wounds.  Inflammation (such as a red bump around a mosquito bite) and the formation of pus (immobilizing the pathogen) are visible effects of your immune system in action.

Your next layer of defense is the linings of your body cavities and pathways, and the components that live there.  Some examples: your ears and nose use wax and secretions and small hairs to catch particles, your sinus cavities trap unwanted particles or pathogens giving your body a chance to tackle them before they cause illness or infection, your saliva is hostile to several pathogens, your stomach acid is a potent agent for killing undesirable pathogens in your food or water, and your stool is an excellent eliminator.  Some pathogens are so potent, that the body immobilizes them rapidly via vomiting or explosive diarrhea—have you ever thought to say “thank you” for those mechanisms!

Once an organism gets past your initial defenses, other mechanisms become activated.  The most common organisms are bacteria and viruses. Bacteria are living organisms that feed on nutrients in your body and then reproduce.  Viruses are not living organisms. They place a fragment of their DNA into your healthy cells. Your cells then act as factories that do the “dirty work” for the viruses by replicating them.

 

Some of you may think that your immune system isn’t working well because you get sick often, or you have a lot of allergies.  In actuality, this is NOT because your immune system isn’t working, but it is working too much and perhaps has become too reactive.  Autoimmune system disorders are the result of the immune system working improperly, almost like a short-circuit in a light fixture.  When the switches should be off, they continue to send signals. Some examples of this are type 1 diabetes, wherein the body attacks its own pancreatic beta cells, rheumatoid arthritis, wherein the body attacks its own joints, and thyroiditis, wherein the body attacks its own thyroid cells.  These are immune system errors. While we understand how these conditions affect the body and often have treatments that slow the processes, we do not have a clear understanding of exactly why these conditions initially occur or how to reverse the underlying mechanisms that initially triggered the immune system malfunction.  We do know that many factors are involved: nutrients, genetics, environmental factors, damaged or unhealthy organs, and others.

Your major immune system players are (take a deep breath):  your thymus (located very near the heart), your spleen (located under the left ribs), your lymphatic system, your bone marrow, your white blood cells (lymphocytes, monocytes, granulocytes, B-cells, plasma cells, T-cells; helper T-cells, killer T-cells, suppressor T-cells, natural killer cells, neutrophils, eosinophils, basophils, phagocytes, and macrophages—whew), your antibodies, your complement system (made in the liver and “complement” your antibodies), your hormones (many!), tumor necrosis factor (able to kill tumor-like cells), interferon (“interferes” with viruses), and your Major Histocompatibility Complex (MHC, also called Human Leukocyte Antigen or HLA) that identifies the cells in your body as being “you.”

Vaccinations are designed to “prime” our immune system.  For several diseases, once the body has been exposed to and handles the disease, it does not recur, for example, mumps or measles.  The B-cells are able to recognize the pathogen and eradicate it before it can multiply and cause disease. Vaccinations contain a very small amount of a disease-causing pathogen in either a live or inactivated form.  They trigger the same response as the disease, but because the vaccine is so much weaker than the actual disease, minimal symptoms occur. If there is exposure to the actual disease in the future, the body handles it very quickly.

When a bacterial infection appears to be overwhelming the immune system, antibiotics will often be prescribed.  These medications are either bacteriocidal—able to kill the bacteria, or bacteriostatic—able to slow the reproduction of the bacteria to give the body a chance to catch up and contain the infection. Antibiotics are NOT effective against viral infections.

Over time, antibiotics can lose their effectiveness, especially if they are used too often. Because of this, a major issue we are facing today is antibiotic “resistance.”  Because bacteria are living organisms, they change over time and can become able to resist the effects of certain antibiotics.

Supporting your immune system is challenging. It is a complicated system with many components.  This list from Harvard Medical School is a good start (with my embellishments added):

    • Don’t smoke.
    • Eat a diet high in fruits and vegetables.
    • Exercise regularly.
    • Maintain a healthy weight.
    • If you drink alcohol, drink only in moderation.
    • Get adequate sleep.
    • Take steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.
    • Try to minimize stress.  Finds ways to laugh and enjoy life.
    • Have regular check-ups with your doctor.
    • Be grateful for your immune system!

 

https://health.howstuffworks.com/human-body/systems/immune/immune-system.htm

https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system

 

©Nov 2018 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.  Schedule an appointment by calling 262.695.5311

Are You Getting Too Much of a Good Thing?

For many people, supplements are an integral part of their daily routine.  Supporting their metabolic processes with vitamins, minerals, green powders, probiotics, and other supplements can certainly improve our health and often speed our recovery from illnesses.  But sometimes, too much of a good thing is no longer good. Many common supplements that are often helpful can harm us when there is an excess in the body. When there is an excess of a nutrient, the body must store or deposit it in places where it would not normally do so.

 

Vitamin D affects the functioning of many body systems.  It is a component of fighting against cancer, improving physical stamina, preventing loss of bone density, maintaining strong teeth, assisting in brain function, and reducing depression.  It is also important for kidney health, immunity, weight management, and sleep. In some studies, optimal levels of vitamin D were associated with reduced symptoms for those with multiple sclerosis.  An excess of vitamin D can result in digestive complaints such as nausea, vomiting, stomach pain, mental fog, thirst, frequent urination, urinary tract stones, or kidney damage/failure.

 

Iron is a key nutrient for fighting infections, building the blood, preventing anemia, increasing brain function, reducing restless leg syndrome, regulating body temperature, and improving sleep by regulating circadian rhythms.  Too much iron is toxic to the heart and the liver and can lead to heart attacks or diabetes. Excess iron has been linked to various forms of cancer. Even though iron has infection-fighting properties, too much iron can actually lead to susceptibility to infections.

 

Iodine is especially important for proper thyroid function.  In the right amount, the thyroid gland uses iodine to convert stored thyroid hormones into active hormones.  In excess, iodine can burn out the thyroid gland and lead to hypothyroidism (low-functioning thyroid). Iodine from kelp sources can be too strong for the thyroid gland when taken on a regular basis.  Initially you might feel better, but in the long run, the thyroid can “burn out.”

 

Magnesium plays a key role in maintaining a healthy blood pressure, balancing water in our body reducing constipation, regulating blood sugar, lessening asthma symptoms, aiding restful sleep, and balancing minerals (calcium, copper, zinc, vitamin D).  In excess, magnesium can cause loose stools, irregular heart rhythms, calcium imbalance, kidney damage, fatigue, and depression

 

Calcium is important for maintaining a healthy blood pressure, building and keeping strong bones, improving muscle tone (strength AND relaxation), lessening hormone abnormalities, protecting the skin from damage, and perhaps playing a role in weight loss.  Too much calcium in your body can cause stones in the urinary tract, constipation, persistent headache, jittery reflexes, thirstiness, irritability or moodiness, loss of appetite, depression, fatigue, or a metallic taste in the mouth.  Excess calcium has also been associated with prostate cancer and heart attacks.

 

While many supplements can provide benefits, they also can interact with other medications or supplements you are taking.  Choose your supplements wisely and always tell your doctor what supplements you are taking.

 

©April2018 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center. She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.  Schedule an appointment by calling 262.695.5311

PATIENT GOALS, PART 1: GETTING OFF YOUR MEDS

As an integrative medicine clinic, we have many patients that come to us with an intention for being completely free of all of their medications.  Many times, the patient wishes to substitute natural remedies for pharmacological medications.  For many patients, we heartily agree.  For other patients, however, it can be quite dangerous to discontinue traditional medications.  If you have this goal, it is very important for you to work with your physician and learn how to do this safely.  Some classes of medication can be easily discontinued, but some can be quite dangerous to abruptly discontinue.  For most medications, the wisest approach is to taper the medication, which means to gradually lower the dose of your medication while watching your laboratory tests and vital signs for adverse effects.  Another method for lowering the dose of your medication is called downward titration.  In this approach, the medication is lowered in a very specific manner, while closely observing symptoms along with test results.

 

For the following medications, abruptly stopping can be quite dangerous or life threatening.  These include insulin (type 1 diabetes), clonidine, propranolol, topiramate, venlafaxine (Effexor), paroxetine (Paxil), benzodiazepines (alprazolam, lorazepam, diazepam and others), gabapentin, opioid pain medications, and baclofen, as well as others.  In the case of clonidine, a person can experience a very serious rebound of high blood pressure, which can lead to stroke.  For propranolol, the heart rate can abruptly rise, leading to chest pain, heart attack or death.  For topiramate, especially when used for headaches, a patient can experience severe rebound headaches. In the case of venlafaxine, also known as Effexor, a person can have sweating, dizziness, fatigue, nausea, tremors, and a feeling of “losing my mind.”  Abrupt paroxetine cessation can lead to severe stabbing headaches and flu-like symptoms and last several weeks.  Benzodiazepines, in general, are notoriously difficult to discontinue.  The shorter-acting the benzodiazepine, the more difficult it is to discontinue and the effects are numerous and varied.  Gabapentin discontinuation, a medication for nerve pain, can cause confusion and disorientation, along with sweating and insomnia.  What makes gabapentin even trickier is that the side effects may not occur for as long as 7 days.  Opioid pain medications are a very specific class of medications that are very difficult to discontinue.  If you have been following some of the stories regarding opiate addiction in the news, you are likely aware of the crisis we are now facing with respect to opiate medications.  

 

For some medications, abrupt withdrawal may not be dangerous, but can be quite uncomfortable. Some of the most common medications in this category are hormone preparations.  The patient who stops their hormone medications abruptly can have a robust return of symptoms, feel moody, irritable, or high strung, and affect the function of other glands, such as the thyroid.

 

Lastly, for some medications, abrupt withdrawal may not be immediately dangerous, but in the long run can be quite hazardous.  Some medications in this class include hypoglycemics for the management of type 2 diabetes, statins for the management of cholesterol, antidepressants for mood/anxiety/depression control, thyroid medications for the management of hypo- or hyperthyroidism, high blood pressure medications, and specialized medications for the treatment of autoimmune conditions such as rheumatoid arthritis.

 

It is very important for you to work with your physician if you wish to discontinue your medications.  In most cases, we will agree with your plan to discontinue medications.  However, in many cases, lifestyle changes need to precede the trial of lowering medications.  For instance, if you wish to discontinue your diabetes medication(s), we will work with you to lower your weight, improve your diet, cleanse your liver, and see if your blood sugar drops to a level that will allow safe discontinuation of your medications.  If there are safe and effective supplements that can be substituted for your pharmacological medications, we will work with you to make those substitutions safely.  While you are lowering your dose of medication(s), you can expect to have more frequent blood work and regular visits with us.  Also keep in mind that the manufacture of supplements is not regulated in the same manner as pharmaceuticals, and the quality of supplements can be quite variable, leading to a less-than-optimal response once the substitution is made.  For example, supplements for lowering cholesterol are often not as effective as pharmaceutical options such as statins.  Let us be your partners in managing your medications—we will work to keep you safe!

 

©September2017 – Genevie Kocourek, M.D. is Board Certified in Family Medicine and practices at The Ommani Center for Integrative Medicine in Pewaukee, WI.  She is the founder of Trinity Integrative Family Medicine and focuses her practice on integrative care and prevention of disease for the entire family.  Schedule an appointment by calling 262.695.5311