The Colors of Relaxation

I was in the very last class of Miss Ivy Hill’s kindergarten in Harriman.  She taught her classes for over thirty years in the upstairs classroom of her home.  The list of accomplishments of students who began their education under her tutelage is impressive.  She never married, but she had hundreds of “her children.”

Each graduate of her kindergarten has in some drawer, box or cedar chest, a large hard bound scrapbook as a reminder of Miss Ivy’s class.  She began each day with an assignment to color a picture from a nursery rhyme with specific instructions of which color to use, where to use that color, and which part to leave for her to complete.  Each week’s project occupies a single page. 

Some would listen to instructions and complete the task.  Others would learn that failure to listen resulted in a second chance to get it right.  The experienced Crayola Crayon artists knew the tricks to garner public praise - a heavy accented border then uniform coloring in the same direction while staying in the lines.  A whiff of a crayon can bring all of that back in an instant.  

It was an experienced educator’s way of teaching listening, focus, concentration, and achievement to a group of five year olds beginning their journey into education.  The scrapbook was an ingenious way to create a physical reminder of the class for the parents and student.  (Mine was better than my brother’s). 

I was reminded of this recently reading an article noting the recent major increase in the interest and sales of “adult coloring books.”  Thankfully that phrase simply means coloring books for adults and NOT coloring books NOT for children.  

The article noted sales of coloring books have increased in 2015 from 1 million to 12 million units.  Oddly, though, the writer took a negative opinion on the trend implying that, even though relaxing to many, coloring is a poor effort at therapy from stress, meditation and creativity.  

Really?  Poor example of creativity?  I just saw a painting of a solid color on canvas displayed in a prestigious museum as a work of brilliance.  Clearly I am not an art expert because it looks just like a single color painted on a canvas.  

The writer went on to say that the therapy, meditation and creativity were lacking because they did not involve professional counseling or guidance.  Really?  A person is not able to find something in life calming and relaxing without the aid of someone who guides it?  I disagree.  

Patients have brought their coloring books to my office delighted to show their work and glowing about how relaxing it is.  There is a sense of achievement with each page and a discussion about colors chosen and patterns created. 

It isn’t loud political arguments.  It isn’t heartbreaking news stories from around the world.  It isn’t a television pitchman wearing either the clothes of a minister or doctor trying to separate a person from their money for promises of a better life.  

It isn’t a digital screen with constantly moving banners.  It isn’t pop up ads rudely hijacking a screen.  It isn’t a low battery alert reminding one of a failure to properly charge last night.  

It isn’t the heartache of thinking, once again, about someone who isn’t there.  

It is just coloring.  Staying inside the lines.  The freedom to pick the color.  The choice of how to develop the pattern.  The uniqueness of the pencil or crayon.  The ability to focus on one thing, one thing only, and to allow everything of this world to be outside the brain and cease weighing down the heart.  

Is that not creativity?  The expression of one’s choices and decisions on a page in front of them?  The lines are there, but the choices are theirs.  

Is that not meditation?  Focusing on one thing, pushing aside the worries of the mind, and claiming a sense of peacefulness and achievement?  

Is that not art?  I’ve seen some harsh creations by artists making a religious statement. Surely the definition of art has already been broadened by now.  

I would even go one step further and suggest that it is an excellent exercise in maintaining cognitive function in older adults.  If I was a university medical professor seeing a leisurely five patients a week, I would propose a grant to study coloring and its effects on sustaining cognitive abilities and reducing memory decline in an aging population. It may actually measure the process.  

My mother began coloring last year.  The loss of my dad meant she had many decisions, adjustments, and changes in her life after sixty years years of having him to talk to about everything.  Now, with the close support of my older brother, she navigated the new life that widows have to learn on their own - rooted within their soul.  

Her coloring books provide a time of peacefulness when the brain seems to settle and focus on matters deeply within the mind.  Her completed pages are beautiful.  She even has one based on her favorite hymn and focuses on the peaceful reassurance of “It Is Well With My Soul” as she colors.  (Hymns - remember those? They are those wordy things in that book sitting in the pew in church)

It is an excellent trend and I hope it continues.  In a world of all things digital, the power of simple hand-eye coordination and expression of thought on a piece of paper is triumphing.  Again.  

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN.  Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Garlicked

My grandfather’s opinion of the kitchen in his house was quite simple. Everyone and everything should work in there except him.  

His concept of refilling his tea was to tap the rim of the nearly empty glass and say “Mary Ann!” My grandmother would then demonstrate moves that would make a linebacker going after a football proud, getting his glass, filling it and returning to her chair to continue her meal. 

So I was fascinated to find him sitting alone at the kitchen table one night actually preparing something to eat. Knife in hand, he was working on bulb looking thing I did not recognize. I was only twelve, not familiar with all the nuances of Western Tennessee cuisine, and was curious what would command such attention from my grandfather. 

(This was the same man who demonstrated the nuances of driving in West Tennessee - down the middle of the two lane road straddling the centerline until you see another driver.) 

“What’s that?” I asked. 

“Garlic.”

“Confused fellow,” I thought. “Garlic is a powder in a bottle that is used to make Funyuns (my favorite - dipped in peanut butter, of course) taste great.”

“It's called a clove,” he explained. “Ever had one?”

“No.”

“It's good for you. Good for your heart. You should try one,” he said as he peeled off a cashew shaped white portion of innocent looking garlic and laid it harmlessly in front of me on the table.

Not wanting to look cowardly to a man who seemed to have no fear, I sat down, took the subtle challenge to my history of finicky eating, and decided to try it. 

All of it. All at once. 

My first clue was the chuckling sound from my grandfather followed by the sound of the blood in my mouth and sinuses running for cover in the back of my skull. It seemed like someone had clamped a battery jumper cable to each of my nostrils, attached the other two clamps to a lightning generator in an old mad scientist movie, and then thrown the switch to the power. 

And the mad scientist was sitting there in front of me laughing like no man of his generation I had ever seen. Glad to make you laugh, Grandad, now how can I put this fire out?

He did this daily. A clove of raw garlic. It didn't even make him flinch. He lived another fifteen years after that with known heart disease and no statin cholesterol medications. 

I've often wondered where he got his information. Research seems to be agreeing with him now. 

A study in the Journal of Nutrition (Jan. 2016) performed at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center revealed some very interesting findings about garlic.  

Matthew J. Budoff, MD, a lead researcher noted in his comments the benefits of garlic in reducing the accumulation of soft plaque and preventing the formation of new plaque in the arteries surrounding the heart.  

Atherosclerosis, or plaque, is the buildup of the lining of an artery which will slowly reduce the flow of blood over time.  In the coronary arteries this means a greater risk of heart attack. In the brain it means a greater risk of stroke (and dementia, some believe). 

The study consisted of 55 obese patients aged 45 to 70 who had high blood pressure, a poor lipid profile and elevated fasting sugar.  It measured plaque in the coronary arteries at the beginning.  The screening was conducted using Cardiac Computed Tomography Angiography (CCTA), a noninvasive imaging technology that accurately measures calcium deposits and plaque buildup in the arteries. Think of it as a very accurate CT scan. 

Part of the group was given placebo and the other portion of the group was given 2,400 mg of Aged Garlic Extract daily.  One year later a follow up scan was obtained.  The garlic had slowed total plaque accumulation by 80%,  reduced soft plaque, and showed regression for low-attenuation plaque.  

Regression means less blockage.  That means the one portion of the plaque actually improved over one year.  Improved is the key word. 

"We have completed four randomized studies, and they have led us to conclude that Aged Garlic Extract can help slow the progression of atherosclerosis and reverse the early stages of heart disease," said Dr. Budoff.  

This is significant in that the study actually demonstrated a change in the size of the build-up in the arteries and not simply improved some numbers on a blood test.  Niacin used to be a favorite supplement because in increased HDL (“good cholesterol”) numbers.  The American College of Cardiology stopped recommending niacin in 2013 as the improved numbers did not translate to improved heart conditions.  

There are other studies which have suggested the same outcome with garlic.  A few noted side effects of garlic are irritation of the stomach, stomach pain, possible bleeding disorders, and allergic reactions. 

Oh, and bad breath.  Even some of the “odorless” garlic pills still can have this.  

Will I recommend garlic to my patients?  Probably so.  This study has some very interesting results and is consistent with others prior to it.   

Will I take the garlic supplement myself?  Likely, as we all add plaque to our arteries as we age and my family clearly has a history of it.  

The problem for me will be the subtle sound of my grandfather’s laughter every time I open the bottle of garlic pills.  He never let me forget it.  

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Coming to a Mosquito Near You - Zika

My patient had a slight fever, muscle pains, red eyes and a very slight rash.  Nothing was exceedingly worrisome, until my next question. 

“Any recent travel?”

The answer was “yes” and revealed travel less than two days prior to one of the countries included in the CDC warning for the Zika virus.  That began a process that is now over four weeks old. 

I contacted the director of the regional health department who called her director in Nashville.  Within two hours we had the form and directions needed for collection of the blood and urine to test for the virus.  

The state has to authorize any testing for the Zika virus and limits the testing to a person with symptoms who has traveled, or had direct contact with someone who has traveled to a country in most of Latin America or the Caribbean.  The reason for this is there is one testing location available in the United States.  

One.  Only one. 

The advice given to me by the director was to advise my patient to stay away from areas with mosquitos.  As it was February and snowing a little outside, I assumed the mosquitos weren’t biting.  She told it would be a while before the test came back.  She wasn’t kidding. 

Most people with Zika have a very limited illness that quickly goes away.  The highly publicized concerns with this virus have been the strong, but not proven, suspected link to severe birth defects.  The infected mothers in the first two trimesters of pregnancy have a much greater chance of a baby born with microcephaly, a condition where the brain literally does not grow beyond the brainstem.  How, why, and how often this occurs is still unclear. 

The patient was kind and understanding and has recovered nicely.  It has been four weeks now and I just received the results of the test.  Four weeks.  The test was negative for Zika and positive for a paranoid doctor.  I’ll take that anyday. 

The other neurological condition seemingly associated with Zika is Guillain-Barré syndrome.  This occurs in a patient who has recently had the virus and their immune system turns against its own body attacking the neurological system.  Severe, temporary but potentially complete paralysis can occur lasting months and sometimes a lifetime.  

Imagine being completely healthy and within one week of a mild virus unable to walk, talk or possibly breath on your own all while completely able to think clearly.  That is Guillain-Barré. It is terrifying to ponder.  I saw this condition twice in Georgia and vividly remember both patients.  

The Zika virus is transmitted by mosquitos in Latin America and the Caribbean.  There have been 200 cases of Zika in the US all associated with a person who had traveled to the areas of concern.  There is a strong suspicion that Zika is sexually transmitted.  It is unclear how long that can be a concern after the infection.  

The virus is transmitted from an infected person to another by a mosquito biting the infected person then biting the next victim.  This is the same pattern of other tropical diseases such as yellow fever, dengue and malaria. 

Is Zika in tears, saliva and urine?  It has been detected, but it is unclear if that means it can be transmitted.  

How long is it possible to transmit Zika?  That is unclear.  

How big of a problem is this going to be this summer?  That, also, is unclear.  But from the sight of the mosquito bellying up to the buffet bar of my pasty white leg last weekend, we shall soon find out.  

Put yourself in the shoes of a young mother excited about her pregnancy in the first twenty-four weeks or so.  Then imagine Zika is being spread across your local region during the summer and that a simple mosquito bite might mean your baby is born with essentially no brain.  The potential for profound fear and worry is tremendous.  

Now imagine there is only one testing center in the United States and that is takes four weeks during the slow month of February to find out if a patient has Zika.  That is a very large problem that is being addressed currently, although no clear information on  how many centers will be available to test and who will perform it.  Eventually a rapid test could possibly be developed. 

We don’t have a treatment for Zika, yet, but it sure would be nice to know if it’s around.  

Potential areas of combating this virus will be vaccines (years), killing mosquitoes (spraying of communities and ridding of standing water) and a very controversial genetically engineered male mosquito which has shown success in Brazil already.  Genetically engineered anything is a controversial topic and the concern of unleashing a genetically altered mosquito versus the anxiety of having a child with a birth defect may make this a passionately debated topic in the news.

Well, at least passionately debated any other year when there isn’t a presidential election parade marching down the main street of the media coverage. 

If a person is traveling to Latin America or the Caribbean, it is advisable to read the CDC travel warnings.  Given the Summer Olympics are in Rio, Brazil this year, this could be a fascinating culmination of fear, freedom, public policy, personal independence, infection control, Olympic dreams, and genetic engineering all wrapped up into one summer story.  

Stay tuned.  There are many people from this region who travel regularly to areas of great need to perform wonderful ministries to people who love and appreciate it.  In less than twenty four hours, that traveler may be standing next to you in the store.  

(On a personal note, I want to wish a very fond farewell and express my deepest thanks to Jason Davis, Editor of The Mountain Press, who announced he is leaving the paper.  I spent many years with Jason on the sidelines of Sevier County’s football games always enjoying his quick smile, great eye for a picture, ready facts of the game and a flowing story to sum it up.  We had the unique privilege of being on the sidelines 11/11/2011 to witness the Herculean comeback win of Sevier County against Dobyns-Bennett from twenty eight points down in the second round of the playoffs.  That column was one of his very best among a collection of many great sports and news pieces.  Thank you, Jason, for giving me the opportunity to publish a column, something I never thought I would do.  It’s been a pleasure to work with you.)

Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN.  His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com