Quarterly Notes

Relationships

This may seem to be a strange topic for an ob/gyn to bring up, but the reality is that not one day goes by that one or usually more patients bring up a relationship issue, and this is usually in the form of marital discourse.

Most people have had more than one significant other in their lives and so most of us understand the difficulties relationships can find themselves in. Most of us begin our relationship or marriage believing that our partner is the most wonderful person in our lives, our best friend, our lover, our “soul mate”, and it is not uncommon that we will tell our partner and vice versa that there is “not one thing we don't like about them”.

Then life steps in, usually in the form of young children, or sometimes job stress, or perhaps financial stress. As we let life step in between ourselves and our partner, thinking it is a temporary stress and that things will “get back to normal soon”, the distance between each of us expands insidiously and before we know it, we are nearing the point of no return. This is about the time my patients are telling me their marriage is in trouble, their husband is moving out, or they haven't been intimate for months-to-years, etc etc.

After the end on an 18 year relationship, I found myself wondering if I would ever have what it took to be successful in any relationship. I was extremely discouraged and felt a strong sense of failure. Without going into too much detail, I can say that we were no different than most couples in believing what we had was invincible and would weather our lifetime. Life gets in the way of those who are not vigilant and before long, the damage that is occurring can seem insurmountable.... but it doesn't have to be.

Over the last several years, I have read many books on relationships and various other personal growth books. This in no way makes me an expert, however, many of my patients have reported back to me that the few books I am about to list have been really enlightening and helpful with regard to their marriages.

I am a believer that multiple modalities can be very helpful, i.e., counseling, whether together or by yourself, “bibliotherapy” (reading books to help understand your relationship better), marriage encounters, etc, can all help, whether one at a time or separately.

A few books that I have found most helpful are as follows:

The Five Love Languages (Dr. Gary Chapman)

Why Marriages Succeed or Fail (John Gottman)

How to Improve Your Marriage Without Talking About it (Patricia Love, Steven Stosny)

The Proper Care and Feeding of Husbands (Dr. Laura Schlessinger)

These are only a few, but extremely powerful books. If I can end this note with any helpful words, I would say that if we just focus on our own weaknesses and not that of our spouses, we might be amazed at how fulfilling it is to try to be better and this allows our spouse the room to grow at his/her own pace.  Giving our spouse the benefit of the doubt as we would want it given to us, save your criticism for yourself but be on your own side in that you take the time to work on yourself and be better for you and your spouse. I know I want my life partner to believe in me, know I am doing my best, give me the benefit of the doubt, be tolerant of my faults, knowing I am well aware of them and don't need having them pointed out but also knowing I will never stop working to be better for myself and for the relationship. If I want these things, I need to be prepared to give them too. No one should be allowed to come in between you and your partner, not your family, friends, children, etc. It is too easy to forget this and if we can remember this we are headed in a great direction.

QUARTERLY NOTES

                                           COMBATTING AGE-RELATED BRAIN DETERIORATION    

One of the many complaints people have as they age is increasing forgetfulness and in general a decline in memory. I hear this frequently in my patients moving into their 40's and on. Some of this may be related to hormonal fluctuations (ie worsening premenstrual syndrome as one ages) but mild-moderate cognitive decline is also a consequence of aging.

In some cases, cognitive decline with aging is a precursor to what will ultimately become dementia and a significant number of Americans will will succumb to cognitive decline and eventually to dementia well before their bodies have given out. In some cases, the cognitive decline that occurs will ultimately lead to the debilitating condition known as Alzheimers or to an Alzheimer-like dementia.

In the October, 2011 article in Life Extension magazine, Dr. Braverman, MD notes that “dementia takes 15-20 years to develop; by 80-85 years of age, up to 50% of Americans will suffer from some form of dementia and by 70 or 80 years of age, nearly every one experiences some cognitive loss.

So how do we protect our brain function? There are several conditions associated with an increased risk of developing dementia. Obesity has been associated with an accelerated rate of brain atrophy and just being overweight in middle age can put an individual at a greater risk for increased cognitive decline. After studies were performed using MRI analysis techniques researchers were able to show that obese people literally have smaller brains than their age-matched controls. Conclusions made from more studies surrounding obesity and cognitive decline surmised that “obesity accelerates cognitive decline, damages attention, erodes memory and decreases the brain's processing speed.”

There is some research that shows women who have undergone surgical menopause and are not receiving hormonal replacement have increased rates of cognitive decline. Similarly, osteoporosis is also linked to increased cognitive decline with aging.

Various drugs accelerate cognitive decline. Some of these drugs include alcohol, tobacco, cocaine, heroin, and marijuana. All of these substances cause activation and neuronal release of dopamie. Dopamine has been called the “feel-good” molecule and people predisposed to abnormal cravings for the above substances often have impulsive behaviors associated to overeating and obesity. Glucose, interestingly enough also causes activation and release of dopamine.

Regular, moderate, exercise, particularly aerobic exercise has been assoicated with reduced odds of having mild cognitive impairment. Exercise also not only improves blood flow and hence oxygenation to the brain but also increases a neurotransmitter called serotonin. Deficiencies of serotonin often lead to depression, fatigue and poor sleep.

Other neurotransmitters involved in cognition and memory are acetycholine, dopamine, gamma-aminobutyric acid (GABA) and lastly brain-derived neurotrophic factor, all of which are increased with exercise and consequently allow for enhanced cognitive function.

In summary, a few simple non-pharmaceutical endeavors can go a long way in preserving our brain function and hopefully retard the age-related cognitive decline so many experience. Keeping our body weight down, exercising regularly, abstaining from high glucose foods and drugs associated with cognitive decline. Alcohol should only being consumed in small quantities if at all. If one doesn't drink, better to never start. My sharpest elderly patient population usually includes women who do not drink at all and never have. Many of us enjoy alcohol in moderation, but strict moderation is important if alcohol has to be a part of one's life since there is little redeeming value in more than small amounts of alcohol and as far as protecting oneself from cognitive decline, abstaining from alcohol is probably the most effective. Hormonal replacement can play an active role in protection from cognitive decline but without embarking off into another very complicated topic, hormonal replacement therapy is something that should be individualized in every circumstance by ones's health care provider.