Mental Health & Wellness – A Conversation with Dr. Ayesha Mian
Can you tell us a bit about your clinical practice?
I am an adult psychiatrist and specialize in Addiction Medicine. I have been in practice for over 6 years. My patients are usually in different phases of their mental illness and/ or addiction disease. I help people get off alcohol and other drugs in a hospital and clinic setting. I also work with people who might be in a state of mental decompensation or seeking assistance to improve their mental health and well-being. I work at Fairfax County Community Services Board, Virginia Hospital Center and my private practice in Arlington, VA.
What are some of the most common mental health issues you see in the community?
Some of the most common issues I deal with are depression, anxiety and alcohol dependence. We live in the day and age of high stress, unrealistic expectations, limited social supports, social media frenzy, breakdown of family structure and abundance of reliance on alcohol and drugs. All these factors contribute to depression and anxiety and these are some of the most common issues I see in the community.
What are some early signs of depression, anxiety?
There are several signs to watch out for with depression- problems with sleep, that is sleeping too much or too little; problems with appetite, that is eating too much or too little resulting in weight loss or weight gain; problems with energy, focus and concentration. People might begin to lose interest in the things they normally find pleasure in, they might begin to isolate and may not be as talkative, they may start to call-in sick at work. Some times if the depression has gone on too long, people might start to feel that life is not worth living. Anxiety may or may not present with depression. When people are anxious, often times they complain of physical symptoms- feeling palpitations or a racing heart, shortness or breath, feeling ‘keyed up’ all the time, worrying constantly about mundane things, feeling overwhelmed etc. There is usually a spectrum of severity with these illnesses. You may only feel some of these symptoms and you may only have them at low intensity and they may progressively get worse. It is important to seek help if you or your loved one might be experiencing such symptoms.
We live in a world filled with multiple stressors. How do you counsel patients about dealing with stress?
I tell people that it is normal to have some degree of ups and downs in your mood with the normal ups and downs of life. It is important to keep a healthy life style, which includes nutritious diet and exercise. 30-40 minutes of cardio 5 or more times a week improves anxiety and low grade depressive symptoms. Incorporating yoga, mindfulness and meditation helps decrease levels of stress as well. Other ways of building resilience include reliance on social relationships, positive thinking and self-care. Human beings are social creatures and we should cultivate relationships in our life, spend quality time with family and friends and rely on our networks in times of need. Oftentimes we don’t reach out for help when we should. The power of positive thinking and having hope in the future are also important as coping skills. Self-care – taking the time out to treat ourself, read a good book, travel, any thing that makes one feel good – are important tools to improve one’s mental health. Eliminating negativity from our lives, decreasing use of social media, putting down our phones and having more meaningful conversations and relationships with people one on one are all coping strategies we can incorporate in our day to day lives.
Have you found a role for “mindfulness” and meditation in reducing stress? Can you talk a bit about that?
Definitely. Mindfulness, in short, is practicing being present in the moment and learning to accept without judgment. There are known benefits of meditation and mindfulness on mental health. Research shows evidence that mindfulness changes the brain. Studies show that the part of the brain called the Anterior Cingulate Cortex, which is associated with self-regulation of impulsivity and aggressive behavior, has higher activity in people who meditate. Meditators and people who practice mindfulness have greater self control and are less impulsive.
In addition, people in stress whether it is psychological or physiological, tend to have higher levels of the stress hormone called cortisol. Studies show that people who practice mindfulness or meditation tend to have thicker gray matter in the region of the brain called the hippocampus, which is involved in memory and emotion. This is the same region of the brain that has a lot of cortisol receptors and is found to be damaged in people with PTSD or depression. So, we actually see physiological benefits on the brain with practice of mindfulness and meditation and I absolutely recommend this to my patients.
There is a stigma in our society not only about mental illness, but also about seeking out counseling for issues like stress, family problems, anxiety etc. Many people are afraid they will be labeled as having a “mental problem” and hence shy away from these resources, or have tried it once and felt a disconnect. What would you advise about the importance of professional counseling and therapy?
Over 18% of the people in the US suffer from some form of mental illness each year. This is not a small number of people. It is important to address mental illness because it can very commonly get to a point where the person becomes dysfunctional in their life and / or it severely negatively impacts their relationships. It can also lead to suicidal or homicidal thoughts, which is considered a medical emergency. We see and hear about people completing suicide because they couldn’t tolerate the suffering and pain of their illness. Therapy and medications do help. You might have to see a few different therapists before you find the right fit, and it is definitely worth the time it takes to find the right person for you. It is important to have a therapist who is neutral (not a friend or family) and would be able to help guide you to discover things about you that you might not be able to otherwise.
How do you approach medication initiation for patients suffering from depression or anxiety?
Depending on the severity and effect of depression or anxiety on a person’s level of functioning, I make a decision on whether a medication needs to be started or not. Some times, people come to me after being referred by their therapist or other doctors. I almost always recommend life style changes – including diet, exercise, limited caffeine intake, meditation, yoga, breathing exercises, therapy etc. Often times, by the time someone is referred to me, these recommendations alone are not enough and we may add a medication. But it really is a decision based on each person’s individual history. There is no one-size-fits-all. I have to assess each person’s medical history, family history, trauma history, genetic predispositions, psychological and social factors, etc. before I can make a recommendation regarding medications.
If I notice a friend or loved one having some serious mental health concerns – (e.g. extremely depressed, paranoid thoughts, irrational behavior) but they are unwilling to see a doctor, what resources are there to seek help?
I come across this a lot. Some times but not always, family and friends have leverage and can do an intervention to convince the person to see a doctor. One way to find a therapist is through your insurance company. Another option is www.psychologytoday.com where you can search for therapists in your zip code and your insurance carrier. Your primary care physician might also know a therapist or psychiatrist they work closely with. Also, all Virginia counties have Community Health Services Boards with emergency services for their county residents. It is hard to get someone to go to treatment against their will, but if someone is in danger of harming self or others, then call 911 or take the person to the nearest emergency room.
What do you think are the biggest barriers to seeking out mental health services – Stigma? Financial coverage? Education and awareness of resources?
All of the above. There is a long way to go in improving the challenge that we see with stigma associated with mental illness. We as health professionals have to continue to create awareness about mental illness as a way to counter the stigma. I also think people don’t know how to recognize mental illness and when they do want to seek help, they do not know where to go. Another barrier is the scarcity of mental health professionals which makes it hard to get an appointment with a psychiatrist in a reasonable amount of time. The hope is that access and availability improves over time and those who need mental health care receive it.
Women’s Health – A Conversation with Dr. Mahnaz Ali
Can you tell us a bit about your clinical practice?
I work at a federally qualified health center called PCC Wellness Community Center in the Chicagoland area. I did my Family Medicine training from MacNeal Hospital and the University of Arizona with a fellowship in Maternal-Child Health at West Suburban Hospital. I practice full spectrum family medicine including OB.
What are some of the leading health concerns you see in women?
Many of women’s office visits are related to: STDs, depression, diabetes, hypertension, heart disease, abnormal menses, hot flashes and obesity.
What are three important screening tests for women?
Pap smears for cervical cancer screening starting at age 21
STD screen once sexually active
Diabetes screen for any age woman with risk factors
I will also say mammograms for breast cancer screening starting at the age of 40.
How important is heart disease as a concern for women?
Very important. Heart disease is the leading cause of death in women.
My daughter’s periods are very irregular, and I was told the pill can help. But I’ve also heard that the pill may not be safe, or may cause problems with fertility later – is that true?
The pill can help with regulating periods. Like any medications, pros and cons have to be weighed with the treatment benefit and the medication’s side effect profile, but the pill does NOT cause issues with fertility.
If my mother or aunt had breast cancer, does that increase my risk, and should I be screened earlier?
It may increase your risk and screening can start early at age 30-35.
At what point should a couple think about fertility testing if they are struggling to have a child?
I recommend patients to try to conceive naturally for 1 year. For women 35 or older, they can seek earlier intervention after 6 months of trying on their own.
What are some dietary recommendations for nursing and post-partum mothers?
I recommend moms to continue to take prenatal vitamins and eat a well balanced meal with iron and calcium.
How often do you see issues of emotional stress, domestic violence or other abuse in the community? What resources are available for women to start seeking help?
We screen all of out patients for domestic violence and most of our patients for anxiety/depression because they are very common. We are lucky to have a behavioral health specialist in each of out clinic sites or access to one in the system. We also have pamphlets and help lines.
Achieving balance always seems a top concern for many women – what advice do you have for women struggling to “balance it all”?
This is a tricky question because I don’t think its possible to “balance it all.” What really helps in trying to “do it all” is a great support system with friends and family. Don’t sweat it if you can’t do things perfectly or exactly the way you want it, things will fall into place.
What are a few positive health habits or routines you would recommend for women?
We all want to have healthy habits, but I think getting a restful sleep and exercising tops the list. Other forms of relaxation that are helping are yoga, meditation and massages.
What is the most rewarding aspect of your job caring for women?
Getting to know women at a more personal level and helping them find a happier place in themselves. I love to see women gain confidence and take charge of their lives.
Caring for Elders – A Conversation with Dr. Saadia Ishaq Husain
A conversation about the issues families face caring for elders – including detecting subtle signs of illness, emotional needs of seniors and caregivers and resources available.
Can you tell us a bit about your clinical practice?
I work as Medical Director and Attending Physician, Geriatrician at Crescent Cities Center, a skilled nursing and Long Term Care facility. This facility is part of Genesis Physician Services. Assessment and management of Geriatric syndromes is one of my areas of clinical interest.
What are some of the unique medical issues you find caring for elders?
Geriatric syndromes like fraility, polypharmacy , mood disorders, fall risk are common in this population.
How about family issues in elder care – what have you seen are common struggles?
There are different kinds of struggles when it comes to family. Some families are very close and wish to take care of their loved ones at home but lack resources. Other times, they have resources but prefer for their relative to move to a long term care setting for closer medical monitoring.
As our parents age, many of us wonder about the early signs and detection of dementia/Alzheimer’s – what are some early warning signs and what are the first steps we should take if we see those?
Early signs in functional elderly are subtle. They are able to, until some point, cover their forgetfulness by other activities that they can still do. We may see them sometimes writing an incorrect check, leaving the stove on, forgetting names, numbers, forgetting or driving directions to a familiar place.
Do seniors have different sleep/wake patterns, and how much sleep should those over the age of 65 get, on average?
Normal aging as well as dementia are associated with major physiologic changes in sleep. Changes can be seen in total sleep time as well as time spent awake after falling asleep. Difficulty with sleep initiation and sleep continuity are most commonchanges . Total sleep time decreases by average of 30 minutes per decade starting in midlife.
What options / resources are there for assistance with caring for elders at home, given our busy lives? Can you also speak to the financial aspects of what insurance may provide coverage for, and what families may have to finance themselves?
It depends on their needs. If they are skilled needs like home IV, wound care, dressing change ,therapy, they are paid by Medicare for nurse or therapist visits at home. However, if we need assistance with Activities of Daily Living like bathing, dressing, toileting, grooming, feeding and transferring, there are home care agencies that provide Home Health Aids who are privately paid on an hourly basis in a common scenario. Typically this is not paid for by Medicare. Social workers work closely with Home Health Agencies to provide families with the aid they need.
Nursing homes have traditionally been a cultural contradiction in our immigrant community. Is that changing, and have you seen more culturally sensitive centers for those who lack the ability to care for their elder family member at home? What questions should one ask about a nursing facility or home when searching?
With ongoing CMS regulations and changes for improvement, I think overall Nursing Home quality is moving in the positive and right direction. However, for immigrant communities, it can still be a cultural shock. The language barrier is first. At this age we prefer people to communicate in our mother tongue. Activities like going out for dinner, playing bingo, going out for movies, music night, etc. may not be something elderly from a different cultural background look forward to.
This area is something that needs a lot of work. I would ask about the daily schedule and flexibility in the schedule, food options, visiting hours, availability of a translator on phone or otherwise, if patient needs one. Also one should inquire about accommodation of patient’s cultural needs, religious activities like praying and celebrating their special occasions etc.
I’ve heard that illness in elderly patients can present in subtle ways, different than younger patients. What are a few “warning symptoms” for families to be tuned in to for early detection of serious health concerns?
Anything different than their normal routine. Missing meals, feeling tired, not hungry, falling or gait changes, low moods , low grade temperature (not necessarily having fevers)… Patients with severe UTI or sepsis may present with generalized weakness as the only symptom. Patient with pneumonia may present with loss of appetite and low grade temperatures and no cough. Stroke can present with acute confusion or a fall.
What do you advise families to help care for the emotional needs of elders? Many seniors seem to fall into a bit of depression or agitation following the loss of spouse or friends, or as their ability to function independently decreases, for example.
I tell them that the presence of loved ones around the elderly is the most effective medication. Families can take turns to be there for them or visit them. Assist them with their meals and basic needs. Identify early if extra help is needed.
How about advice for children caring for aging parents – certain legal considerations they should look into, and also how to manage the stress of the caregiver role?
Again taking turns and getting extra help is important. Caregivers should not feel exhausted on a day to day basis. If a caregiver is always tired, something is not right and needs to change. Caregivers should not feel guilty or bad expressing their concern of work load to social workers, other family or PCP.
How important is establishing a daily routine/pattern for elders? How about exercise?
Daily routine is important in all ages but crucial in the geriatric population. At the same time we cannot be very rigid if a person is not up to it on a certain day. It is important to do some exercise as a routine for mental, psychological as well as physical wellbeing. Some nursing homes have exercise routines for elderly based on their capacity.
How would you advise helping seniors balance a sense of independence while also maintaining safety? (For example, when it may not be safe to drive alone, etc.)
There is no easy answer to that. Taking away your driving license is taking away all your independence. That is how they feel. It needs a lot of education and reinforcement and replacing that activity with something enjoyable is important. It is a team effort and the decision should be made in collaboration with families and a plan of care should include alternatives.
What is the most rewarding aspect of your job caring for elders, and what would you advise others in regard to this special generation?
I lost both my parents. I have a special place in my heart for elderly patients. Every parent, every elderly person, has the right to be cared for and loved in this time of their lives more than ever before. It is very rewarding when they hug me and feel loved and cared for. Sitting by their bed and holding their hands and listening to them makes my day and theirs too. My advice is that if we get the opportunity to take care of elders, be mindful of their needs as they may not express them like other people. They need company and should not feel lonely. They should be taken care of as a whole person rather than as a list of medical problems.