Lifestyle Medicine, Anxiety, and Beverages of Choice

I’d seen this patient a couple times before, but today was the first time that I knew in advance that he would be coming, and I was able to clear my schedule for a full one-hour appointment. The last visit, I just couldn’t figure out why the medications weren’t working, and he was already at about he maximum amount which I felt comfortable dosing. He was struggling from low mood, and even though that was improving, none of my treatments had done anything for the anxiety or the difficulty sleeping.

He had gained some weight, too, and today I had some time to ask more in-depth questions about nutrition and exercise. I know that doctors in America would love to have an hour with their patients, and I know I’m fortunate. Because it doesn’t take me long to figure out one of the roots of the problem. My patient is drinking a big cup of coffee on an empty stomach, right when he wakes up. He might have a bit of toast (or not) then another big pot of coffee mid-morning. Lunch is decently big, but heavy with simple carbohydrates which will give quick energy and cause a sugar low. Not much protein to get him through his busy day as an NGO worker. And then another big cup of coffee, and another and another, with the final and 5th cup of the day not long before bedtime. I know a thing or two about caffeine, as I have to be very careful with my tea habit to not get shakes drinking black tea on an empty stomach, and not having any caffeine after lunchtime. So it’s easy enough to dive in. I can’t say for sure that the coffee is the cause of his problems, but I am nearing certain confidence that cutting back on the caffeine will help the anxiety and insomnia.

Lifestyle changes aren’t easy. I share some information about the power of caffeine on an empty stomach, especially when it comes to anxiety. We discuss alternatives such as decaf or smaller cups, lower-caffeine tea alternatives and higher protein meal options. I know that cutting down on caffeine can lead to headaches and feeling ill, so we talk about that as well. I suggest that caffeine at night could impact his sleep, and he listens as if he’s considered it for the first time.

I know it’s unlikely that everything will change at once, but now that my patient has some information and some achievable goals that he came up with himself, I am confident that he will find improvements which are even greater than more medications could have brought. I let out a sigh of relief, it’s not always that there are root causes easy enough to change like this, especially when it comes to anxiety and insomnia. But I’m optimistic here. I book him for a follow up in 4 weeks, remind him of my email in case he wants to contact me beforehand, and I go home with a little less tension in my shoulders. At least this one patient has a way forward and a hope for remarkable improvement in a short amount of time.

Learning to Love

I have been trying to learn about love this month, partly because February seems like a good time for it, but also because love seems to be the place to start when it comes to figuring out everything from the meaning of life and greatest commandment to the fruit of the spirit and who I’m supposed to be. I have been learning new ways of engaging scripture. Lectio Divinio does not come easy to me, but I try over and over with 1 Corinthians 13 – the chapter where Paul talks about love – and by the end I’ve memorized it, though I can’t say I totally understand it. I don’t like the way that the 2011 NIV changes the word rude, but I’m still not sure what it means. I find it interesting that many descriptions of love – patient, kind, perseverant – echos the fruit of the spirit quite a bit.

I also notice that there is always one place where I mess up the citation of the verse – toward the end when it lists some final factors of love, I want to say that love “always serves, always protects, always hopes, always trusts.” But it’s actually “always protects, always trusts, always hopes, always perseveres.” In that “always” section I invariably want to add “service” to the list of things that characterizes love. I even had to check a lot of different versions to make sure I didn’t pick it up from somewhere. Nope, that is just me, trying to insert doing something productive into a description of love.

It makes so much sense to me. Even when I’m trying to be present, my mind is racing with new projects, new productive things I can do. When a friend is sharing her feelings with me, I want to think what I can do or how I can make it better. I even get restless when someone is giving something to me and I can’t give them something back. I know that love is the greatest commandment and the beginning of spirituality, but it is so hard for me to get beyond the idea that love doesn’t “always serve.”

So I can identify a hold up, but trying to address it is even harder. It doesn’t seem in my nature to stop trying to strive, stop trying to serve, stop being Martha and sit at the feet of Jesus more like Mary. Some days I don’t know where to start trying to reform my ideas and trying to renew my mind. So I pray for God to teach me to love as I breathe in and breathe out throughout the day. I try to protect my heart and soul by not jumping into every opportunity which presents itself, so that I can have some ability to be intentional on things more internal. Sometimes I don’t know how to move forward or what is next, because the default of service is so tangible, so easy to imagine. Yet so tempting towards both burnout and a sense of self-importance. I don’t quite have a plan for how to move forward, but I think it will have something to do with trust, hope, and perseverance.

A Day Off: February 2023 Update

It was a beautiful, sunny Saturday. We had power and water at home, so it was easy to make tea and breakfast when I woke up. I listened to the birds and enjoyed the green and the flowers in the yard. Then Greg and I got an early start, we left for the Lilongwe Farmer’s Market just past 8. We arrived while there was still parking, and you could still see the beautiful trees all around as the parking lot hadn’t filled up yet with cars. We walked along some stalls we have seen for many years – our favorite artist with some impressive new works in oil, watercolor, and pencil; the lady who makes incredible bagels; the guy who sells fresh butter lettuce, already cleaned in the bag for 30 cents. Some vendors had finally increased their prices after the devaluation of local currency by about 50% in the last year. Our favorite basil garlic dressing is about the same price it was last year, but eggs and pastries and honey is much cheaper in comparison.

There were some new stalls this time - a lady selling freshly made peanut butter for about a dollar a pound; a group making fresh unscented body moisturizer using local ingredients; a leatherworker with products which were a bit beyond my budget or current needs. I splurged on a new pair of earrings and some sizeable tubs of moringa and neem powder- supplements considered to help build immunity and health – all for under $2 each. There are some more expensive things – bean to bar Malawian chocolate truffles are almost $3 for a 4-pack, but worth the investment once a month in my estimation.

Greg and I sit down at a table and order a tea and a coffee. Prices haven’t gone up in the nearby restaurant, so we’ll pay just over $1 for both drinks. By the time we sit down, the market is starting to swell with almost every diplomat and expatriate in the city, and some of the surrounding areas. I recognize many of the people – a large percentage have come to consult me in clinic over the years. I see a group of our friends walking over and I wave. They have just arrived, and are happy to join us at our table between browsing the stalls. We talk about the market and about trips home and about our ministries and about health and about our spouses and about nothing in particular. Normally Greg is in a rush to leave the business of the market, but he knows most of these people and enjoys sitting and chatting. We see Wanda, who came to the city in her new car; we see our friends who rarely leave their own business; at first we are excited to see them walking along the stalls, until we realize they are working, planning which new products to bring to their store. We eat a baguette; we move around the table as the sun changes.

After two hours at the market, we collect our many purchases and go home. It is a restful rest of the day, with reading and napping and iced tea, snacks and a show or two. At dinnertime we go to a friend’s house for dinner, chatting, and watching some TV shows from the 1970’s. I feel rested, I feel fulfilled. I know that life is not always like this, not always restful, not always surrounded by those who care for you. In some ways we dwell in abundance here, able to take days off and buy comparative luxury items at a market. I hope that this day will build strength and resilience for the days to come, days when everything might not be so sunny and bright. But boy, it sure was a nice day.

This month, please continue joining us in prayer for as Christina recovers from further illness Greg begins teaching in the new semester.

Thank you for your prayers and support, - Christina + Greg