Happiness versus Joy

Happiness	Unhappiness	Joy
Red Lamborghini	Totaled Corvette with a $15,000 unpaid note	A walk in the park
Corner office in Petronas Towers	Windowless basement office	Contentment in all things
Night with a desperate housewife	Sexually transmitted disease	A wife of noble character
Executive power	Servitude	A willing and obedient heart
Fully funded 401-K	Bear market at retirement	Generosity
Fame and fortune	Harassed and helpless	Humble and grateful service
Tequila Sunrise	Hangover	A fruitful vine
Intelligent and knowledgeable	Ignorant and apathetic	Wise and discerning
Superiority	Inferiority	Selflessness
Possessing worldly things	Craving, lusting, boasting	A virtuous life
Pride in accomplishments	Arrogance and hubris	Warm-hearted appreciation

Noncompliance

Two admissions today. One was discharged yesterday. Went home to find she had been robbed of TV, Stereo, and money. Decompensated began to devil was inside her. This lady so washed out on drugs she has a vacuous appearance. Very flat and no life. Discharged her yesterday because we felt nothing else could be done. Thought that she might immediately return to drugs because cocaine is only substance that can bring life to her attitude. Sadly, every time she uses cocaine she depletes more dopamine from brain which only increases her apathy and craving. Had no money for drugs and decompensated. When go to hospital delusional and hallucinating with downcast gaze and no life in eyes.

Second admission was discharged about nine months ago. Said discharge meds helped a great deal, but never returned to MHMR to get a refill of meds and slowly developed delusions, suicidal thoughts, and voices telling her to kill self.

LYRICA IN THE TREATMENT OF FIBROMYALGIA

Lyrica, the first treatment for neuropathic pain associated with Diabetic Peripheral Neuropathy, is indicated for the management of Fibromyalgia, Postherpetic Neuralgia, and as adjunctive therapy for adults with Partial Onset Seizures.

CHARACTERISTICS OF FIBROMYALGIA

v    Core symptom of fibromyalgia is chronic widespread pain, associated with diffuse tenderness

v    Patients demonstrate pain on palpation in at least 11 of 18 tender points

v    Fibromyalgia is believed to be a dysfunctional hyperexcitability in pain processing

MECHANISM OF ACTION OF LYRICA

v    Although the exact mechanism of action is unknown, results from animal models indicate that the analgesic effects of Lyrica may be associated with the following functions:

ü     Lyrica crosses the blood-brain barrier to bind to the 2-delta subunit to close presynaptic calcium channels diminishing excessive neuronal activity.

ü     Decreases the release of the excitatory neurotransmitter glutamate

ü     Decreases substance P

ü     May work in the central nervous system to reduce the level of perceived pain

ONSET OF ACTION

v    Can reduce neuropathic pain and anxiety in one week.  

METABOLISM

v    No liver metabolism

v    Hepatic impairment mandates no dose adjustment

v    Lyrica is excreted renally 

v    Can be removed by hemodialysis.

Dosing recommendations

v    Initial dose = 75 mg. twice daily 

v    At week one as needed increase to 150 mg. twice daily

v    Maximum dose = 225 mg twice daily (450 mg daily)

v    Discontinue gradually over minimum of one week

o      Flat pricing across dosage strengths

SIDE EFFECTS

v    Dizziness

v    Somnolence

v    Cognitive slowing, difficulty concentrating, or poor attention span

v    Fatigue

v    Dry mouth

v    Blurred vision

v    Weight gain

v    Edema

v    Patients with a creatinine clearance of 30 to 60 mL/min had a greater incidence of discontinuation due to adverse reactions than patients with normal creatinine clearance

Consults

Called for consult at SJRMC. BHU, in Navasota is about 35 miles from SJRMC making consults difficult. About the only thing dreadful about the recorders job. Lady had complications from gastric stapling surgery June 2007. Has been in hospital taking care of multiple surgical complications for 6 1/2 months so far. Was depressed and crying when seen a couple of days before. Placed her on Geodon 20 mg IM feeling better, but can't keep giving injections. Having trouble sleeping. Discontinued IM Geodon and started on Seroquel 20 mg--very low dose to improve sleep and also workup to therapeutic dose for depression. Placed on Remeron for depressing which will also help with sleep. Meds had to be given via GI tube.

SMART GOALS

Goal directed planning provides a guideline for helping others. Goals can be achieved by following the SMART acronym:

o      Smart goals. The eternal question is this: Will we live to achieve our personal goals, comfort and pleasure, or will we establish goals that direct us toward serving God and others? The eternal way, the smart way, enables us to establish goals designed to use our talents, gifts, skills and abilities to serve others and honor God.

o      Measurable—Goals must be specific as “I will write from 6-7 AM Monday-Saturday.”

o      Achievable—Goals must be sensible. Anyone can write an hour daily if they are motivated.  

o      Realistic—Establishing a goal to write 8 hours daily is impossible unless you are Stephen King who writes from 8 AM to 5 PM each day.

o      Time oriented—An absence of a specific time to accomplish your goals makes measuring your progress impossible.

ANXIETY AND WORRY CAUSING PHYSICAL SYMPTOMS

Disorder	Symptoms	Examples
Somatoform Disorder	Physical complaints with no physical findings	·      Fibromyalgia ·      Hypochondriasis ·      Somatization disorder
Conversion Disorder	Anxiety/Anger converted into one symptom that cannot be explained by a medical condition	·      Paralysis of an extremity with normal reflexes ·      Pseudoseizures (false seizures) ·      Vomiting with no physical causes ·      Pain without physical findings ·      Blindness with pupils that dilate when exposed to light
Psychosomatic Illness	Physical illness in which emotional factors contribute	·      Ulcers ·      Most headaches ·      High blood pressure ·      Irritable bowel syndrome ·      Heart attack ·      Asthma

Foosball

A Foosball table has 8 rods. Figures placed along the rods are used for hitting the ball when the rod is twisted. The object of the game is to knock your ball into your opponent's goal  by twisting and turning your attached rods. Your opponent tries to get his ball into your hole. This is a fast moving game. People who have played  video games have the advantage. Older people with reduced reflexes have  a disadvantage. Even though the old people lose, they have fun trying.  Young and old notice their pulse racing and everyone breathes harder than usual. Some people sweat a little. Everybody laughs. It's fun even if you lose.  You hardly ever get bored playing this game.

A Cabin off Hickory Nut Gap Road near Banner Elk, North Carolina

Driving north toward Banner Elk from Sugar Mountain on State Highway 184 turn left onto Hickory Nut Gap Road. Drive up the mountain via numerous switch backs for 7 or 8 miles and you will come to a gate on the left that when opened allows you to drive up a gravel road to a cabin. Enter the small foyer and peak to your left to see a small kitchen . Straight ahead is a modest living area with a fireplace on the back wall. Sliding doors lead to a deck. Between the kitchen and the living area is a dinning table that will seat eight comfortably. If you wander back toward the small kitchen and look to your left, you will find a bedroom with a king size bed. To your right is a similar bedroom with another king size bed. The bedroom on the right has a stone shower. The other bedroom has a tub sitting on legs.The upstairs loft has a bunk bed and two single beds. No bathroom, but comfortable. In the basement is a nice pool table and a foosball machine. Outside is a charcoal grill. There are several hiking trails from he cabin. Some lead to the creek below; others meander in meadows. It is a very pleasant cabin. The nicest we have enjoyed in North Carolina.

Luck

A big part of my game plan is...luck.

True Power

Take from me all pride and vanity, all boasting and forwardness, and give me the true courage that shows itself by gentleness, the true wisdom that shows itself by simplicity, and the true power that shows itself by humility.

Attitude is Everything

Two shoe salesmen were given a new territory on a Pacific island. Immediately upon arrival, the first sales­man placed an urgent call to the home office:  "Get me out of here. No one on this island wears shoes."

The second salesman sent an e-mail request to the factory, "Please put everybody on overtime. Will need as many shoes as you can manufacture. No one on this island has any shoes."

Attitude determines the difference between shoed or shoeless. Attitude is more critical than events. It's more significant than what's happened or what's hap­pening. Attitude is more consequential than the past, than genetics, than education, than money. Attitude is more important than what other people think... say, or do. It is more important than appearance or tal­ent. Attitude will make or break an individual, a home, a company, or a country.

Whether we are running hot, running cold, or sim­ply running on overload, we can take charge of our atti­tude by choosing enthusiasm. Corporate presidents voted enthusiasm the most valuable personality trait. Enthusiasm is the biggest single factor in successful selling. Enthusiam wins ball games. Inspires audiences. Enhances learning. Builds team spirit. Propels careers.

Because attitude determines whether we are happy or unhappy, the positive perspective assures us that we can never fail. A hopeful attitude guarantees internal success. Attitude—the altitude adjuster—determines whether we fly high or low, crash or soar, glide or slide.

Attitude Aphorisms

Whether we are running hot, running cold, or sim­ply running on overload, we can take charge of our atti­tude by remembering these aphorisms:

• Success has more to do with our emotional disposition than with our social position.
  
• Kites rise against the wind, not with it.
  
• A rubber band becomes effective only when it's stretched.
  
• More opportunities exist than there are people willing to seize them.
  
• What matters is what happens in us not to us.
  
• You can tell when you are on the road to success.  It's uphill all the way.
  
• When Goliath appeared, David said, "He's so big, I can't miss."
  
• Wait until the lows pass and you will feel on top            of things.
  
• Choices, not circumstances, determine how we think.
  
• Because action cures misery change your motion to create positive emotion.
  
• Where there is no faith in the future, there is no power in the present.
  
• To accept failure as final is to be finally a failure.
  
• Failure is the line of least persistence.
  
• Others can stop us temporarily, but we are the only ones who can stop ourselves permanently.
  

The Power of Optimism

A fishing guide once said that catching a trout depends more on who's holding the pole than the bait that's on the hook. "Optimists catch more fish," he said. "They believe they're going to catch 'em and they catch 'em."

Optimism helps athletes. Swimmers were given a psychological test that measured attitude. Those who scored high on optimism performed better after a defeat. Swimmers who scored low on optimism performed worse after a defeat.

Optimism helps students. Psychologists gave col­lege freshmen tests to measure optimism. Four years later, the psychologists found that optimism predicted grades better than SAT scores or high-school grades.

Optimism helps sales people. About three quarters of insurance, salesmen quit in their first three years. Guess what? Pessimists quit twice as often as optimists. Optimistic insurance sales people sell almost forty per­cent more insurance than pessimists sell.

An insurance company hired a special group of applicants who failed the normal screening tests, but scored high on optimism. The first year on the job the "dumb" optimists sold 21% more insurance than 'the "smart" pessimists. The second year, the optimists sold 57% more insurance than the pessimists. "Dumb" opti­mists sell more insurance than "smart" pessimists.

By a mountain stream, in classrooms, on an athletic field, or while making sales calls, optimists do better. Empirical findings and scientific studies indicate that optimists are more successful in all aspects of life than pessimists. Because optimists are more resilient, they turn defeat into victory.

Overcoming Procrastination

Procrastination, doing low-priority tasks before high priority activities, robs us of valuable time. We usually do the least important things first because they are easier. We put off the most important things because they are hardier. When we work on the unimportant, we worry about the crucial tasks that aren't getting done. We get tension headaches. Ulcers. High blood pressure.  Our doctors get rich, but we still haven't done what's most important. There are four major reasons for pro­crastination:

1. Laziness

To defeat laziness, begin. Once moving, you'll tend to keep going. It takes greater energy to start an activi­ty than to sustain it. For example, if you're writing a screen play, put something on paper. Forget about sharpening pencils, arranging paper, reading one more script for inspiration. Write. Writers write.

2. The Quest for Perfection

  Nobody is perfect. Nothing created by anybody is perfect. Stop fretting about getting everything just right. Learn to do your best and accept the results. Expecting perfection never gets anything accomplished. To continue with the writing analogy, get that first draft done. Forget semicolons, active verbs, dangling participles, mixed metaphors. Just get something down on  paper. You can revise and rewrite the screenplay later.

3. Indecisiveness

 To overcome indecisiveness, use the ready, fire, aim approach. Fire it up there. Then aim it. Make some mistakes. Learn. Adjust. Move on.

4. Difficult Tasks

Break down a difficult task into easy steps. Just do a little at a time. You write a screenplay or a book one page at a time. Write one page a day and at the end of a year you will have written 365 pages.

A Rhetorical Question: What Makes a Man Abusive?

In the eyes of society he is successful. He has been married almost 50 years. He is a retired insurance executive. He is a lay preacher. He reads the Bible daily. He prays twice daily. He beats his wife every few days. He won't repent. He says she deserves the beatings because she disappoints him.

How can this happen? I don't know. I can't explain it.

I do know that I can't judge others, because I myself sin daily. My worst sins are those that I know are wrong and yet I do them anyway. At other times, I sin and am not even aware of my transgressions. I tend to make excuses and blame others.  I may not beat my wife, but I still fall short of the glory of God.

For her physical safety and for her self-esteem, the abused woman must leave her husband. She probably won't.

How can she not leave? I don't know. I can't explain it.

Some family member must protect the abused wife by convincing her to leave her husband. Adult Protective Services should be notified.

The rest of us can pray. Pray for the abusive husband. Pray for the abused wife. Ask God to forgive our sins. Prayer answers all rhetorical questions.

Everyone is Special

 A low-self imagine comes from a society that devalues the average. Our society emphasizes looks, intelligence, athletic achievement, and wealth. God views each person as a precious gem. God loves each of us equally. All of us have a unique gift. That unique gift is God's love and acceptance. In the eyes of God, the plain girl and the less intelligent man have just as much worth as those valued by society. Society's view is temporary. God's view is eternal. 

The ABCDs of Behavior.

The trained mind knows that thoughts about events are more powerful than the events themselves. When we learn to shape our thinking, we use our minds to overcome a series of unfortunate events. We can improve our attitude by using the ABCDs of behavior.

Ø    A = Activating event—Someone may criticize your tendency to dominate meetings.

Ø    B = Belief about the event—You initially believe that the critical person is a jerk. As you reflect on the situation, you conclude that this criticism may be valid. In the past, people have joked about your dominating personality. They have rolled their eyes and looked bored when you talked. You decide the critical person is correct in the assessment.

Ø    C = Consequence of the belief—You feel a strong determination to change your behavior while, at the same time, you feel grateful that you have received constructive criticism.

Ø    D = Doing—The action you take is based on your belief, not on the activating event. You begin to talk less and listen more. 

Type A and Type B Behavior

TYPE A BEHAVIOR	TYPE B BEHAVIOR
Impatient	Patient
Aggressive	Causal lifestyle
Sense of time urgency	Enjoys the moment
Highly competitive	Useful. Helpful
Interrupts others’ speech	Good listener
Craves recognition	Appreciates leisure and beauty
Frequently checks time	Rarely looks at watch
Obsessed with multitasking	Does things one at a time
Seeks fame, wealth and power	Enjoys work
Quick tempered	Peaceful deliberate thinker
Angry	Expresses affection openly
Rapid speech	Slow, deliberate speech
Inability to relax	Calm
Facial tension	Smiles and laughs easily
Always seeking more	Enjoys the present
Complainer	Content
Tongue and teeth clicking	Tranquil expressions
Audible forced inspiration of air	Relaxed breathing
Perfectionist	Accepts own imperfections

AS HAPPY AS APPLE PIE

Psychological studies indicate that just as we seem to have a set point for wealth, we also have a set point for happiness. Through controlled experiments, psychologist Sonja Lyubomirsky, PhD has explored ways to beat the genetic set point for happiness. According to Dr. Lyubomirsky, if happiness resembled an apple pie, the flavor of that pie would depend on the following three factors:

·      50% of the pie’s happiness depends on our genetic set point. Studies of twins and adoptees show that 50% of our happiness/unhappiness response can be explained by the way Mother Nature mixes the chromosomes we inherit from our parents. An upward swing in happiness eventually falls back to our happiness baseline. Likewise, a mind-messing downswing will gradually return to our genetic set point for happiness

·      10% of the pie’s happiness comes from life circumstances. Our income, marriage, children, occupation, physical health and where we live contributes 10% to our overall chance to experience happiness.

·      40% of the pie’s flavor develops from learned emotional and behavioral factors. How we act and how we respond to circumstances contributes 40% of our overall chance to experience happiness.

60,000 Thoughts A Day

Scientists estimate that we create approximately 60,000 thoughts a day. Most of these thoughts—about 95 percent—are repetitive. These thoughts make up our philosophy of life, our personality. One way to change our personality is to change our thought patterns through a concentrated effort to think healthier. And then to go beyond positive thinking, we need to experience and give love.

            Excellent health goes beyond positive thinking to include a positive philosophy of life. Positive thinking is better than negative thinking, but a benevolent view of life is better still. Those individuals who view life with equanimity, peace, and joy are much more likely to have excellent physical health. Feeling—really feeling loved by God—and knowing—really knowing that God's spirit dwells in us—changes the biochemistry of our bodies in a beneficial way.

            Self-understanding, learning, stretching the mind, and observing will enable us to cultivate the positive forces in the universe, in ourselves and in others. When we cultivate a more loving perspective about our lives, and ourselves we gradually develop a healthier philosophy of life. Daily praying for the gifts of the spirit—love, joy, peace of mind, wisdom, humility, patience, self-control, kindness and gentleness—can lead to positive changes.