As the semester winds down, this is a good time to reflect back on the many experiences of the past several months, the academic challenges, the clinical opportunities, the formation of new friendships, and the strengthening of old friendships. As we reflect, take some time to be thankful for the special opportunities you have been given. With the holidays approaching, it is also a good time to re-initiate contact with someone you have not seen for awhile or with someone who is in need of your time and attention.

We certainly wish everyone a happy and successful new year. In particular, our thoughts go out to the M4s who will be interviewing and selecting residencies for the 1999 match. Best of luck to everyone!

Doctors in Texas are conducting a study of arthroscopic knee surgery. Patients with sore, worn knees are assigned to one of three procedures – scraping out the knee joint, washing out the joint, or doing nothing.

In the "nothing" operation, doctors anesthetize the patient, make three incisions in the knee as if to insert the usual instruments, and then pretend to operate. Two years after surgery, patients who underwent the pretend surgery reported the same amount of relief from pain and swelling as those who had received the actual treatments.

A recent review of placebo-controlled studies of modern anti-depressant drugs found that placebos and genuine drugs worked about as well. "If you expect to get better, you will," said Dr. Irving Kirsch, a psychiatrist at the University of Connecticut who carried out the review.

Placebos are about 55-60 percent as effective as most active medications like aspirin and codeine for controlling pain. Scientists thought that placebos might work by releasing endorphins, but that is not the only explanation, according to Dr. Kirsch.

While placebos can act globally on the body, they can also have extremely specific effects. For example, consider this study in Japan on 13 people who were extremely allergic to poison ivy. Each was rubbed on one arm with a harmless leaf but were told it was poison ivy and touched on the other arm with poison ivy and told it was harmless.

All 13 broke out in rash where the harmless leaf contacted their skin. Only two reacted to the poison leaves.

Consistently, studies have shown that placebos can work wonders. The question is, why? Explanations can be found in a new field of cognitive neuropsychology called "expectancy theory" – what the brain believes about the immediate future.

Like classical conditioning theory – remember Pavlov’s dogs? – expectancy involves associative learning. The medical treatments you get during your life are conditioning trials, Kirsch said.

The doctor’s white coat, nurse’s voice, smell of disinfectant, or needle prick have acquired meaning through previous learning, producing an expectation of relief from symptoms. Each pill or injection is paired with active ingredients that work, and later, if you get a pill without active ingredients, you can still get a therapeutic effect, he said.

Such conditioning shows how expectations are acquired, but it does not explain the strength and persistence of placebo effects. These responses occur almost instantly, with no apparent conscious thought.

Response expectations are strong because the world is filled with ambiguity. A long thin object seen in dim light could be a stick or a snake. But it may not be safe to take the time to find out. So people evolved a mechanism to anticipate what is going to occur. This expectation speeds the perceptual processing at the expense of accuracy.

Undoubtedly, the research will continue to shed light on the mind’s ability to heal the body. In the meantime, if a patient’s immune system is induced to fight back, what difference does it make to the patient if it’s because of the placebo effect or pharmacological agents?

Excerpted from the Omaha World Herald, November 2, 1998, pg 12

"No one can make you feel inferior without your consent."   Eleanor Roosevelt

"Live so that you wouldn’t be ashamed to sell the family parrot to the town gossip."   Will Rogers

1. Sustaining attention: The premier factor in learning to sustain your attention, is finding a quiet, safe place and a time that suits you during which to meditate. A quiet, bright room with not much in it to distract the mind is ideal. You may wish to shut your eyes during sitting meditation. Minimize both internal and external distractions as much as possible. It is not especially productive to meditate when you have something else to do, or when you're pressed for time. It's better to set aside a period – say, in the early morning or in the evening when you get home – when you can really give your full attention to the practice. Begin with 15 minutes or so. Practice sincerely within the limitations of time and available energy, and avoid becoming mechanical about the routine. Meditation practice, supported by genuine willingness to investigate and make peace with oneself, will develop naturally in terms of duration, skill, and effect.
2. Focusing on the body: The idea in focusing on the body is to find the proper combination of stillness and energy. Sit comfortably on a chair or the floor with your back straight without strain. Collect your attention and begin to move it slowly down your body. Notice the sensations. Relax any tensions, particularly in the face, neck, and hands. Allow the eyelids to close or half close. Investigate how you are feeling. Expectant or tense? Then relax your attention to your body a little. You may find thoughts drifting into your mind, just let them drift on by. Focus more on your body, if thoughts become intrusive. Remember, what you are looking for is the proper balance.
3. Becoming aware of breathing: Follow the sensation of your ordinary breath as it flows in through the nostrils and fills the chest and abdomen. Try maintaining your attention at one point, such as the nostrils or diaphragm. Breathing has a tranquilizing quality, steady and relaxing, if you don’t force it. Your mind may wander, but keep patiently returning to your breathing. As you inhale, imagine that you are breathing in qualities of peace, well-being, tolerance, forgiveness, patience, and the like. As you exhale, imagine that you are expelling unwanted feelings and stress.
4. Opening the mind: Rather than to create a "trance," the purpose of meditation is to allow you to notice the workings of the mind and to bring a measure of peaceful clarity into it. The entire process develops mindfulness, patience, and insightful understanding.

You may find it helpful to use limited self-talk during meditation, such as repeating a phrase or even a single word. Pay attention to your reaction to whatever words you choose. If your reaction is uncomfortable, select something else. Allow yourself to experiment from day to day with different words. What works for you will change.

Music activates several areas of the brain simultaneously and this may make it more difficult for you to meditate. In general, very patterned auditory stimuli (such as music) are more distracting than helpful, but experiment if you feel strongly about it.

Remember:

1. There is no one "right" way to meditate. You’ll recognize if you’re on a helpful track as you pay attention to your mind and body.
2. Incorporating any new activity into your life takes a little structure and planning, as well as practice and patience.
3. You can reap the benefits of meditation in proportion to the amount of effort and enjoyment you put into it.
4. Meditation is not a mysterious, exotic practice that’s foreign to the western hemisphere. Most of us participate in various forms of it naturally, we just may not consciously be aware that’s what we’re doing.
5. It’s natural to resist letting yourself meditate. Meditation just feels good and we have been enculturated to believe "no pain, no gain." Just tell yourself it’s okay, even if you feel a little strange at first. The results are worth it.

A good professional will be able to teach you what you need to know about specific exercises and techniques as well as diet and mental conditioning. Get input about your current program and find out your options for making it work even better. If you’re not exercising at all, start out slowly. Your workout should be challenging, but fairly easy to accomplish. Remember, it isn’t just your body that’s changing, your mind needs to change too. You need to adjust to a new routine and you may have to overcome some misconceptions and fears. Talk to your trainer and experienced friends. Get support wherever you can.

Many exercise programs forget to take diet seriously and a person might think, "When I work out, I can eat whatever I want!" or "I don’t need to eat much, I feel great!" You need a well-balanced diet that gives you enough of the right kind of calories to support and increase your muscle mass while reducing unlean mass. Muscle mass requires 50% more calories than does unlean body mass. By simply adding muscle mass or toning unlean mass you will burn more calories at rest because your resting metabolic state will be increased. But that doesn’t mean that all calories are created equal. A good trainer will be able to explain protein, carbohydrates, and fats to you, or refer you to a nutritionist if you need additional information.

In general, the Harris-Benedict Equation can help you assess your daily caloric needs (DCN):

women = 655 + (body weight in kgs x 9.6) + (height in cms x 1.85) - (4.7 x age)

men = 655 + (body weight in kgs x 13.7) + (height in cms x 5) - (6.8 x age)

To figure your weight in kgs, take your current weight in pounds / 2.2

To figure your height in cms, take your current height in inches x 2.54

Multiply your DCN by your activity level of 1.1 to 2 (for example, a marathon runner may have an activity level of 1.9; a person who exercises 3-5 days per week for 30-45 minutes per workout may have an activity level of 1.5).

The average person needs 0.8 grams of protein for every lean pound of body mass. Endurance athletes may need as much as 2 grams per pound of lean body mass. Protein intake is extremely important if you are interested in attaining a greater muscle mass. Each gram of protein contains 4 calories, as does carbohydrates. Each gram of fat is 9 calories. Figuring out your diet requires some math, but it will be well worth your effort in order to maximize your results.

Red-Pepper Sauce
2 tsp olive oil	2 sweet red peppers, coarsely chopped
2 lbs tomatoes, quartered	½ cup flat-leaf parsley leaves
4 garlic cloves, minced	2 tsp balsamic vinegar
¼ tsp freshly ground black pepper
Lasagna
9 lasagna noodles	1 tsp olive oil
1 green bell pepper, thinly sliced	1 sweet red pepper, thinly sliced
2 cups nonfat ricotta cheese	¼ cup egg substitute
2 tbsp grated parmesan cheese	2 tsp dried basil
Pinch of grated nutmeg	½ cup shredded nonfat mozzarella cheese
1 cup canned cannellini beans, rinsed and drained

To make the red-pepper sauce: Warm the oil in a large no-stick frying pan over medium heat. Sauté the red peppers for 5 minutes. Add tomatoes, parsley, and garlic. Cover and simmer, stirring frequently, for 20-25 minutes. Transfer to a blender, add vinegar and black pepper, and process until smooth.

Wellness Council
Rudy Puana, Catherine Rush, Rich Lichti, Emily Richardson, Reagan Wittek, Emile Wakim, Kim King, Amy Kelly

Wellness Committees
Spirituality, Exercise/Fitness, Nutrition, Mental Health, Relationships

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