As a prescribing psychologist, I've been to medical school and graduate school so I know the dangers of smoking before surgery. But I can also see how someone without medical training might think as one patient said to me a week ago, "What's the big deal? I know surgery can be dangerous but why do I have to quit smoking to get it? After all, surgery only lasts a couple of hours, can't I just quit the day before?"
Here's why the big deal... Did you know that smoking can place the success of your surgery at risk?
How smoking can mess with your surgery
1. Healing: Smoking affects your body’s ability to heal and recover after surgery. Nicotine and other harmful chemicals in cigarettes constrict blood vessels, which can lead to reduced blood flow and oxygen delivery to the surgical site. This can delay the healing process and increase the risk of infection. Pretend you're trying to wash a gash on your hand. You're hand is bleeding because you were planting a garden and mistakenly punched a hole in the palm of your hand. You go to the sink with blood and dirt on your hand but when you turn the water on, just a trickle of water comes out. The pipes are clogged with gook and crud so the water can't get through. Minimal water means minimal flow to the injury. Now picture your smoking as creating a clog or narrowing in your blood vessels such that the healing oxygen can't get to the wound like it does for non-smokers. Since bariatric surgery involves cutting and stapling the intestines, the reduced blood flow can result in infections because oxygen is the primary source of wound healing.
2. Blood Clots: Let's stick with the bathroom pipes metaphor because another concern is that smoking can increase the likelihood of developing blood clots. After bariatric surgery, smokers are at a higher risk of developing blood clots due to the changes in blood flow and the length of the procedure. Smoking further increases this risk by thickening the blood and reducing the body’s ability to break down clots. So imagine now that instead of nice clear water struggling through the pipes, your smoker's pipes have a mud water consistency. Instead of a clear flexible flow, you have more of a sludge trying to pass through the pipes. Are you picturing things getting backed up and occasionally stuck? Because that's what can happen to your blood during and after surgery.
3. Pulmonary Complications: You probably could have guessed this one on your own. After any surgery, you may experience breathing issues. If you are a smoker, you likely already have damaged lungs, making it difficult to get enough oxygen needed for healing. This can decrease your lungs’ ability to fight off infections, leaving you vulnerable to develop pneumonia or other respiratory complications after surgery.
4. Marginal Ulcers: Ulcers are already common in smoking adults, but after bariatric surgery, the risk of developing an ulcer significantly increases. In a healthy adult, ulcers heal naturally by pumping blood to the stomach. After the surgery, however, the smaller stomach limits blood flow to the stomach and affects the ability of ulcers to heal.
In general, smokers after bariatric surgery have a 30% increased risk of complications. Long-term smoking can even decrease your ability to lose weight and increase the risk of future complications, such as ulcers at the site of surgery.
You risk surgery postponement or cancellation if you smoke within four weeks prior to your procedure. Some surgeons will not risk performing the surgery AT ALL due to the complications and difficult healing process brought upon by smoking.
Why you should quit before surgery
There are many reasons why quitting smoking before bariatric surgery is crucial. But probably the most obvious is that most of you have made the decision to lose weight with surgery to improve your health and life span. So why would you put yourself at risk for surgical complications and an early death by continuing to smoke?
I can hear many of you now, "Don't you think I've tried!??! Do you think I like smoking when I know it causes emphysema, lung cancer, wrinkled skin and all the many problems I hear from doctors ALL THE time?"
Well, I have a bit of positive news for you. According to the American Red Cross, it takes a smoker, on average, 7 attempts to quit before they quit for good. So, I'm including resources here to help get you to #7.
Resources for Quitting Smoking
1. The New Mexico Quitline: The Quitline is a free, confidential service that provides support and resources to help smokers quit. They offer coaching over the phone, online support, and nicotine replacement therapy.
2. The American Lung Association (Quit Assist): The American Lung Association has a variety of resources to help smokers quit, including online support, quit smoking guides, and a Lung HelpLine.
3. Smokefree.gov: Smokefree.gov is a website that offers free resources to help smokers quit. They have online tools and resources, as well as a text messaging program that provides support and encouragement.
4. Nicotine Anonymous Online: Nicotine Anonymous is a support group for people who want to quit smoking. They also have in-person meetings in many cities across the United States and offer a 12-step program to help smokers quit.
Medicines to help you quit smoking
There are several medications available that can help you quit smoking, including:
1. Nicotine replacement therapy: This includes nicotine patches, gum, lozenges, and inhalers that contain controlled doses of nicotine. They can help reduce nicotine cravings and withdrawal symptoms.
2. Bupropion: This is a prescription antidepressant that can also help reduce nicotine cravings and withdrawal symptoms.
3. Varenicline: This is a prescription medication that can reduce the pleasure you get from smoking and help reduce nicotine cravings and withdrawal symptoms.
Phone Apps to help you stop smoking
1. Quit Genius: This app offers personalized coaching and a cognitive behavioral therapy program to help you quit smoking.
2. Smoke Free: This app tracks your progress, provides motivational messages, and offers tips to help you quit smoking.
3. Quit Smoking Slowly: This app provides a 90-day quit smoking plan that helps you gradually reduce your tobacco intake until you can quit completely.
Remember, quitting smoking can be difficult, but it is possible. Combining online support with an app and maybe medication, can increase your chances of success. Remember to check with your bariatric surgeon for limitations with regard to medicines you can take before and after surgery.
Everyone is different so don't be afraid to make mistakes, just keep reminding yourself that your striving for not only a longer life, but one with better quality where you can run, ride a bike, take hikes, play with your kids or grandkids without getting winde. And if you need a little more motivation, how about some images?
If your the kind of person who would spend more time looking for your list than accepting that you should just create a new list, you may be a perfectionist.
Are you a perfectionist? The Frost Multidimensional Perfectionism Scale (FMPS) was developed as a survey for measuring perfectionism.
Clinical perfectionism commonly correlates with the following psychiatric diagnoses:
Common Perfectionistic Behaviors
Perfectionism can be a challenging mindset to deal with, but with some understanding and strategies, it's possible to manage it in a healthy way. Here are some tips that may help if your struggling with perfectionism:
Remember, perfectionism is a mindset that can be managed with time and effort. Being kind to yourself, is a way to start the journey.
It's taken a lot of work opening more appointments for therapy. I've struggled with the idea of retiring and spending more time taking care of me. But then I get the phone call, "Do you have any openings? "I need help." Or "I'm having panic attacks."
Or "I can't get rid of my OCD. It's breaking up my marriage."
I hang up the phone and look around my office and think..."I love spending time here. I want to help." Finding balance is also important.
It's a three-legged stool that won't stand when one leg is missing. "Write more books!" I tell myself. "That's working too."
While that's true, writing is really a passion of mine, I just read about a recent study from Harvard that found the "key" to happiness.
The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health,” said Robert Waldinger, director of the study, a psychiatrist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School. “Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."
These findings made a great impression on me and sealed my decision to spend a more time in the office.
What is psychotherapy when you cut through all the cognitive reframing, behavioral strategies, and lifestyle changes? Therapy is all about RELATIONSHIPS. I can prescribe all the right medications, all the strategies, but if I don't have a solid, caring relationship, my patient will never connect with my recommendations. It's just so much more blah, blah, blah.
Yes, sometimes I commit the cardinal sin of going overtime when something important comes up at the end of session. But, I've always had that problem, even when I was in the Air Force. I'd make up for it during my admin. time or I'd book fewer patients in the day because my patients were deploying 5-6 times and it felt too unnatural to say, "Time's up" in the middle of a breakthrough about the meaning of an important loss. It's not something I've ever been proud of, lack of discipline and such. But now that I think about it, maybe spending that extra little bit of time was helping me too. All because of the RELATIONSHIP.
To those callers I haven't work with, it may seem like I was being uncaring. But, I'm more convinced than ever that if I can't connect with your needs within the context of our relationship, then taking you on as a patient is really the worst version of being uncaring. Connecting through the relationship means caring and commitment. Commitment of time, commitment of resources, commitment to sharing the pain on the way to discovery/recovery.
I'm not here for the money, because we know that past a certain income, money does nothing for happiness. In fact, this same Harvard study in the Gazette used an example of a lawyer who was making tons of money and who felt unhappy as hell.
Really what I'm doing here is pushing a bit harder instead of retiring - building a few more relationships. Opening that straighter path to happiness. So let's see if you're right you Harvard researchers, if you're not, there's a certain Calla Lilies painting that's coming home with me sometime next year.
A Life Changer
Diabetes can take you from a fun, carefree life to a boot-camp existence in the blink of an eye. One morning you're minding your own business, eating, drinking, resting... watching Queen of the South on Netflix. Next thing, you're at a doctor's appointment for a routine exam being told, "You've got Type 2 diabetes". It was something you were always afraid could happen. Your mother has it, your grandmother had it, and your sister too. It was always kind of a ticking time bomb. But now the KAPOW has happened and you're feeling the sting of all the changes you're going to have to make to stay alive. Stay alive??
Diabetes is a killer. Six people will die from complications of diabetes every minute somewhere in the world. Diabetes is one of the top ten causes of death in the United States.
How did I get here?
You might think that it's purely genetic but if you have Type 2 Diabetes Mellitus, it's very likely that you're overweight. In fact, people with severe obesity are 4 times more likely to get it. What's worse, you have an 80 percent greater chance of dying early because of this disease. Science has shown that you will live a shorter life, on average by about 10-15 years, if you have this condition.
How do I get out of here?
Well, there's always medicines, diet and exercise. But how many people are really able to keep their lifestyle on this straight and narrow path? Not only that, but the medicines you'll need to keep your blood sugars in check will add up along over time. So will the doses you'll need to stay on top of the condition.
I believe that bariatric surgery is a meaningful treatment for Type 2 diabetes. Diabetes goes into remission for almost 80% of Type 2 diabetic patients who get bariatric surgery. And if it doesn't resolve, chances are high that you will see your:
Am I a Candidate for Bariatric Surgery?
Typically you must have a BMI over 35 in addition to diabetes in order for insurance to pay for WLS. If your BMI is over 40, you are considered to have "Morbid Obesity" and are more likely be covered.
Don't know your BMI? Check it here: www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Irene, our office manager and all-around caretaker for our PsyConOps practice has had WLS. She is always happy to share her insights, and she can sign you up for our Bariatric Support Group where you can meet people who have had the surgery and want to help others. We have developed a warm and welcoming community of people who understand what it's like to struggle with weight and who haven't lost hope. If you're shy and don't want to do anything formal, just give us a call at 575-652-4383. Tell us your concerns or ask your questions. You'll discover very quickly, that we really are here to support your needs. Hablamos Espanol.
I believe this will be my last blog post on Autism Spectrum Disorder (ASD). I don't consider myself an expert on this topic, but I've done a number of ASD evaluations by this stage in my career, and I've collected multiple resources that I regularly share with my patients who are on the spectrum. I know it may sound unfair, but I favor therapy with people who are neurodiverse; they remind me that there are so many different ways to look at, and behave in, the world. Much of the time, Aspie's (individuals with the formerly used diagnosis of Asperger's syndrome), have no idea how valuable they are to society. Questioning norms. Refusing to accept unreasonable or illogical norms, they are sometimes blunt to the point of pain. These individuals will often place truth above social pleasantries, sometimes with unintended results such as losing friendships. Like they say, "If you REALLY want toknow how you look in that red dress, ask an Aspie."
Truthfully, sometimes I feel crushed by the need for ASD assessments here in Las Cruces, NM. I have a waiting list and it's tough telling the people who call that I won't be able to see them for months. If there are any psychologists in the local area reading this who are conducting these evaluations besides me... HELP!
In the mean time, here is a list of Ten Resources I've discovered for Adults who are or are exploring whether they are on the Spectrum and who want to know more AND who live in New Mexico.
Am I on the Spectrum?
These websites offer a nice compilation of tests you can take online for FREE to start your journey toward discovering whether you're on the spectrum. Remember these sites only offer screening tools and can't diagnose you. They are, however, a good way to start your exploration and may offer some insight you can bring with you to any psychological evaluation to kick things off.
1. Musings of an Aspie: https://musingsofanaspie.com/aspie-tests/
2. Aspie Tests: www.aspietests.org/
3. Embrace Autism: https://embrace-autism.com/aspie-quiz/
Now that I Know I'm on the Spectrum. What next?
There is a New Mexico Autism Society that offers advocacy, education and support, services specific to NM. According to their website, they can support you by explaining state and federal legislation to assist families and individuals with autism. They plan activities for families and individuals with autism. They work to improve resources and are partnered with the Autism Society of America. They collaborate autism programs at the Center for Development and Disability at UNM and work with autism providers throughout the state.
5. Disability Financial Support
Adults with Asperger's syndrome may qualify for Social Security disability benefits. An adult with autism can apply for SSI or SSDI (SSDI is only available to you if you have a work history from jobs that paid Social Security taxes). Satisfying the requirements of a disability is not the only way to be approved for disability benefits. Individuals whose claims are not approved on the basis of specified disability listing can still seek help through a medical vocational allowance. For more information, you can visit or call the local Social Security Office in Las Cruces:
Las Cruces Office2141 Summit Court
Las Cruces NM 88011
If you live elsewhere in the state of NM, you can find your local office through this website page: www.disabilitycarecenter.org/state-resources/new-mexico-social-security-disability/
6. New Mexico State Resources
This NM government website is associated with the Developmental Disabilities Supports Division (DDSD) of New Mexico. They help with resources provided by the state for children and adults with Autism Spectrum Disorder (ASD) and their families: https://www.nmhealth.org/about/ddsd/pgsv/autism/. Additional information and resources can also be found in the Autism Supports Training section of their website. They include Training links like:
7. Help with Accessing Services
To start accessing services for ASD, consider: Autism Spectrum Disorder Portal website. This is the NM Center for Development and Disability. This website has some cool features like a podcast specifically on Autism, a resource locator, online training, and even some support in Spanish. It looks like the Spanish section is a work in progress, but I went to the page and this is what they say,
8. For Spanish monolinguals
If you need autism resources including filling out social security or DD waiver forms, support groups, and have language barriers or do not know how to navigate the health system, you can call them at 505-925-6022 or send an email at: HSC-AutismPrograms @ salud.unm.edu
I could only find two ASD-focused therapy resources in Las Cruces, NM. I apologize but I don't have direct experience with either one of them. Most of the people I see already have counselors but they don't know they are on the spectrum until they come in for an evaluation so I don't get to see where they go once they've been diagnosed. If you know of a therapist that specializes in ASD issues/concerns, please feel free to reach out to me so I can add them to this list.
9. Counseling Las Cruces
133 Wyatt Dr UNIT 3
10. Aprendamos Intervention Team
301 Perkins Drive Suite B
Las Cruces, NM 88005
Please, Pretty Please! Help Me Add to this List
If you know of some great people, resources or places here in New Mexico that can help adults on the spectrum, please send me your suggestions. You will be helping your community and that feels good!
A mom recently asked me why is her Asperger's son is so cold? His error-- not sending her a card for her birthday.
"I told him that all I wanted was a little card from him, just something to show he cares, but he completely ignores what I need."
Is her son really a cold-hearted user who just takes and takes without giving anything back?
THE REAL DEAL: Asperger's doesn't make people cold-hearted or even uncaring. But they DO have a HARD TIME with seeing the world from another's perspective. WHY? Because people with Asperger’s see the world from their own, mostly different, point of view.
Here are some of the ways they see things differently,
- A Neurotypical person walks in a meeting room and scans the people sitting around the table, maybe checking for whose the most attractive, or the most powerful, or the best dressed. They are using the moment to get a layout of what is going on in that moment and considering what is expected of them as they walk in. Maybe even coming up with strategies for how they can meet those expectations.
- An Aspie walks in the same meeting room and sees the details -- the bright lighting above him, the sound of a woman's pen tapping on the table... he looks down and sees trip hazards from computer cords crisscrossing the floor.
A Neurotypical person meets a new contact and looks them in the eyes while saying, "Hi. Nice to meet you."
An Aspie meets a new contact and does not look them in the eye because it feels "too intense". And they may mumble, "Hi." But don't ask them what that person looked like five minutes after its over. Most of the time, they will have trouble giving you a useful description.
So now that we know there's a difference. What about the son's indifference?
People with Aspergers typically care about how others feel, especially people they are connected to like a mother or father or a close friend, but they are more likely to consider their own way of looking at things first and then they get stuck there. So, in this case of a mom wanting a birthday card from her son, the son might think, "I have to go out and pick something out. Then I have to get myself to a post office... I hate going to places with long lines...
Before he knows it, the task has morphed into a horror show and he tells himself, he'll do it later.
Oh, also PROCRASTINATION can be a b-tch for people with Asperger's.
So now, his mother's birthday comes around and her son has failed to honor his mother's "simple" request for a card because it's not really that simple for him. Also, because he has difficulty taking on his mother's point of view, he wonder's, "Why is a card such a big deal?"
If you ask him, "How would you feel if someone you loved didn't acknowledge your birthday?" He'd probably say, "Fine with me. I don't like a lot of attention on my birthday."
SO YOU SEE: Ignoring the birthday card has very little to do with his mom, and EVERYTHING to do with how her son sees the world. If you asked him, "Do you love your mom?" He'd probably say, "Yeah. I do." But the difference between what he feels and what he THINKS and DOES can be really different.
If you think you might have Asperger's and that it was missed when you were a child, I can help. Just give us a call, and we can get you scheduled for an evaluation.
I'm working on a new book again. Every so often a topic presents itself as a book in my life, mostly through personal experience. Then I get obsessed. A subject for a book attacks me and becomes an itch that I need to scratch.
My first book about the Camino de Santiago was an attempt to make sense out of a life changing event-- walking an ancient pilgrimage in Spain. I wrote that book in a year while obsessing about the things that happened to me on that 500-mile journey. After that, I took a breather but the itch came back. I needed to share the lessons I gained from working with divorcing couples in the military. Every time I got tired and felt like giving up on that manuscript, I would see images of the people who survived their separation/divorce because of the principles I'd taught them. Those memories became a cattle prod for my lack of motivation and resulted in a book that, according to reviews, has stopped a lot of suffering.
And now, I'm driven by a new obsession. It happened as a result of COVID-19 when my Aspie son came to stay with us after he suffered a house fire. He is on the autism spectrum and is no longer a child. Our conflicts, and sometimes heated arguments got me to thinking about the learning curve we parents of adult Aspies (people with Asperger's syndrome) go through as we navigate the world of neurodiversity. When he was young and I wrestled with his diagnosis, there was a part of me that understood the disorder as a psychologist, but another side of me that just didn't get it.
"How could a kid with a Superior IQ have problems holding one end of a basic conversation?"
It was like watching a person playing a complicated board game and making it to Square 10, but collapsing on Square One. How was that even possible? Like Spock from Star Trek, who I swear was on the spectrum, for me, it was "not logical".
Physics-no problem. Calculus-Roger that. Software programming-check. Responding when someone says, "Cold weather isn't it"-Panic attack!
What's up with that?
First It Helps to Consider What the Science Says
According to the Diagnostic and Statistical Manual of the American Psychiatric Association, the diagnostic criteria for Autism Spectrum Disorder requires that a child show persistent deficits in each of three areas of social communication and interaction. I've tried to call attention to the main concerns by underlining and using red font.
Here is a downloadable link to the DSM V criteria.
AND at least two of four types of restricted, repetitive behaviors:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
Next post I'll try to make sense of these criteria by showing what they look like in the real world with real people. But in the mean time, I'll leave you with a real-world neuro-diversity success.
Is it COVID or just a Bad Pillow?
I saw a patient last week who told me that she can't sleep at night. "I watch CNN before I go to bed. Between COVID and the elections, my head is spinning. By the time I close my laptop and turn the lights off, I'm too wound up to sleep. Should I get a better pillow?"
There are two sleep robbers in her story. Can you guess what they are?
Ok, she wasn't drinking coffee at night. But... Computers and CNN!
Computer screens (including our phones) emit short-wavelength, artificial blue light. Although staring at blue lights during the day tends to boost attention and mood, long blasts of those blue light rays at night doesn't do much for sleep. Correction. It does affect sleep, just in a BAD way. Blue light:
Melatonin: The Hormone of Darkness
You've seen commercials for melatonin as a sleeping pill. But did you know that your pineal glad produces melatonin all by itself for no cost?
There's only one problem. Our brain only produces melatonin at night--in darkness. You know where this is going. Exposure to light, prevents the natural release of melatonin that makes us sleepy at night. Even dim light can reduce melatonin secretion. Stephen Lockley, a Harvard sleep researcher says, "Light at night is part of the reason so many people don't get enough sleep." Short sleep increases your risk for depression, diabetes and heart disease.
So turn off those computers at least an hour before bed. Or if you are truly an addict, dim your screen light to the lowest you can stand. Maybe the frustration of barely seeing the screen will get you to put your computer away and turn on some chill music instead.
What about CNN you ask? You probably already know why watching emotionally-charged, worry-inducing, heart-racing news interferes with sleep.
Do you have trouble falling asleep? Tell us why?
I was supposed to attend an herbal intensive in Taos this weekend but because of COVID-19, the event was held virtually. I'm more of a hermit anyway, so the idea of getting the information in my own quiet space was still appealing. The instructor, Tiarona Low Dog, a physician and master herbalist, offered all I expected and more. There are so many ways to understand medicine. I'll start by saying that they're not just pills you down with a cool glass of water and a big swallow.
Medicine Is Lots of Things
Medicine can be an herb that you add to your food, like turmeric that is a powerful anti-inflammatory used often in Indian cuisine. The antihypertensive called garlic that you mince and cook up with some great pesto. It can be the L-theanine "chill-axation" you get with a nice oolong tea.
I can't remember the last time (before this class) that I thought of food as medicine. I'm too used to stuffing my face with the things I love, like refined sugars and carbs: pasta, potatoes, cookies and ice cream. I'm more inclined to think of my meals as a minefield of calories, carbs and weight gain. Could there really be some hidden society of sages that choose their food based on a decision to feel good or to relieve depression and anxiety? Yes! And they were at my herbal conference with Dr. Low Dog this weekend. I even discovered that you can reduce the glycemic load of your meal by 35%, just by adding an acid like vinegar, lemon or lime juice,
How cool is that?
But back to herbs for mental health...
Trophorestoratives for the Brain.
A Trophorestorative is a food that has an affinity for a specific body tissue or organ and that works to restore normal function. Today, we're going to look at one trophorestorative that has an affinity for the central nervous system, your brain and spinal cord with all its circuitry of nerves that allow you to feel a pin prick, or pins and needles when a leg or arm "falls asleep".
Omega-3 fatty acids
You've probably gotten used to thinking of Omega 3 fatty acids as a heart healthy food, but did you know that it's also good for brain health?
Omega 3's EPA and DHA have been shown to be helpful for reducing depression, attention deficit hyperactivity disorder, and other mental disorders, most likely because of their impact on the production of neurotransmitters like dopamine and serotonin. Check out the effects of your typical antidepressant and you'll see that all of them increase one or both of the same neurotransmitters!
O-3's also support communication between neurons which can boost the brain's ability to remember.
Omega-3 fatty acids EPA and DHA can be found in wild cold water fish like salmon, herring, sardines, and mackerel. Your body can also produce EPA and DHA out of another omega-3 called alpha-linolenic acid (ALA) found in walnuts, flaxseeds, chia seeds and soybeans. And don't forget seaweed and avocados!
Gotta go make dinner now. I'll get back to the things I learned this weekend in my next blog post.
Elaine Orabona Foster, Ph.D.