Are pregnant women more likely to develop Bell’s palsy?

pregnancy-dr-dee-questions

Are pregnant women more likely to develop Bell’s palsy?

Answer: As a reminder, Bell’s palsy is caused by dysfunction of the facial nerve (also known as cranial nerve VII). This leads to paralysis of face and other muscles that receive signals from that nerve. One study shows that pregnant women are 3x more likely to develop Bell’s palsy than non-pregnant women. It most often occurs anywhere from the 3rd trimester to up to 1 week post-delivery. One proposed explanation is that during pregnancy, the body’s immune system is suppressed. Therefore, the pregnant woman is more susceptible to the virus that is linked to Bell’s palsy.
#AskDrDee
#boardcertifiedneurologist #boardcertifiedneurophysiologist #neurology #drdeemd @ Birmingham, Alabama

“It’s Intentional”

“From where we stand, the rain seems random. If we could stand somewhere else, we would see the order in it.”

-Jim Chee in Coyote Waits by Tony Hillerman

I hate small talk.

I mean I really, really hate it.

The other guy doesn’t actually care if I’m here on business. And I don’t want to talk about where he snorkeled last summer. But we do this same dance EVERY TIME! Why? Because we’re supposed to. Silence would be too awkward. What’s worse is that the seats on an airplane are so close, I could perform a fundoscopic exam on the gentleman next to me. So, once again, here we are doing the familiar, which seems pointless…

“What’s your name?”

“Dee.” I answer coyly but succinct.

“Where you from, Dee?”

“Alabama…how about you?”

“Alpharetta, Georgia…hey, I’m Mike,” answering as he extended his hand.

“Nice to meet you.”

But I don’t know if this will be a nice encounter, do I? My inner dialogue made me chuckle in my head.

Listen, it’s not that I don’t like talking to people. For Pete’s sake, I’m a physician. It’s actually that I am an introvert. Superficial interactions drive me insane. I thrive on deeper connections and thoughtful conversations. I’d rather not do what is merely expected but what I purpose to do. If you ascribe to a spiritual or metaphysical sense, you believe “all things have purpose,” even casual exchanges. This one was no different.

“What’s taking you to Tampa, Dee?”

“Work conference…you?” I quickly diverted the attention away from me.

“Heading down for a bone marrow biopsy. I have this thing called aplastic anemia, which is a variant of MDS. Do you know what that is?”

I smile. “Myelodysplastic syndrome.”

Shocked, he replied, “No layperson would know that.”

“I’m a neurologist.”

From medical treatments and complications to faith and family, the conversation lasted the entire flight. It ended with him needing to use my phone to call the Uber carrying him to the medical center. He’d left his at home. We said our goodbyes and offered well wishes. This time, I really meant it. The hope in his eyes reassured me. By the time we landed, it was apparent that this was not a casual encounter. Our lives were meant to intersect.

Inconvenience has purpose. It teaches us how to listen…to be patient…to give…to grow. Today, I learned that being an introvert is not an excuse to avoid a seemingly trivial interaction. As person and a physician, I must evolve to a greater understanding of the haphazard yet masterful design that allows strangers’ paths to cross. Every interaction, in its own way, is intentional.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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*A fundoscopic exam is the part of the physical exam where the physician uses an ophthalmoscope to look in the patient’s eye trying to visualize the optic disk. An ophthalmoscope is a tool used to magnify the posterior surface of the eye while looking through the pupil.

Oops, ID DID IT AGAIN!

“She made broken look beautiful and strong look invincible. She walked with the Universe on her shoulders and it look like a pair of wings.”

– Ariana Dancu

Has a thought ever peeked around the curtain of your subconscious long enough for you to know it should stay there? But before your ego could suppress it, the id was running out of the portal of your head called your mouth. Known as Freudian slips, classical psychologists deem these so-called misstatements revelations of the underlying, unconscious thoughts or feelings. According to Sigmund Freud, the father of psychoanalysis, unacceptable thoughts are locked away from the conscious awareness. According to him, when these thoughts “slip through,” it reveals deeper intention. Cognitive psychologists, however, attribute these errors to phonetic similarities or links to emotional context. Either way, a “slip of the tongue” is often embarrassing and humorous when it occurs.

This happened to me in the form of a text sent to a friend recently. When I read it back to myself, I was mortified and tickled. That’s one thing about me…I find humor in the most morbid and embarrassing times. My sister and I caught a case of the giggles at my aunt’s funeral a few years back. We thought she would be laughing too at some of the shenanigans that took place. I remember how surreal it was to see her lying there, but I couldn’t stop laughing. Psychologists believe humor to be a “mature” defense mechanism. I feel my humor reflects my true, childlike nature making sense of life’s intricacies.

As a neurologist, I give life-altering diagnoses on a regular basis. I observe the gamut of patient reactions. Early in my career, I worried less about the patients who cracked a joke after hearing serious news. With deeper introspection, I now circle back more often to these patients, the “strongest of these”…those laughing instead of crying…those who smile to reassure their loved one that all is well. I see myself in them, just frightened kids trying to reconstruct shattered moments in time. Rehearsing mature responses doesn’t replace their need for empathy. To the contrary, the “strong ones” need more love and attention. After all, they usually give the world the most.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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*According to Sigmund Freud’s model of the mind, the psyche is comprised of the “id,” “ego,” and “superego.” The id is the portion of the mind based in instinctive drives and impulses. Developmentally, id precedes the ego, which when functional serves to rationalize id’s desires and mediate them with reality. One’s superego is where the conscience is housed, being filled with ideals and principles of perfection. Freudian psychologists see these three facets in constant conflict. To overcome this, the ego creates defense mechanisms.

“Book Cover”

Who are you to judge the life I live? I know I’m not perfect-and I don’t live to be-but before you start pointing fingers…make sure your hands are clean!”

– Bob Marley

In high school, I didn’t become popular until my junior year. I know, I know…hard to believe, right? LOL… No really…most students felt I was nice and reserved. The girls found me cool and non-threatening, which is important in the ranks of teen girls. The guys thought I was a cute nerd. My presence didn’t rock the boat too much. This one guy, however, would never hesitate to let me know how special I was.

He was a football player and an underclassman. This upperclassman thought, “what more juvenile combination could there be?” I found him annoying at first and would dismiss his advances as jock talk. But with time, I looked forward to the flirtatious banter and yes…eventually, I became his girlfriend. How sweet, right? To us, we were on our own planet. Yet, our social solar system somehow became misaligned by our union. Several teachers, administrators, and parents felt we were from “different side of the tracks.” At the time, I was being groomed to be school queen, and “guys from his neighborhood” were viewed as “troublemakers.” Veiled by the innocence of our affection, it didn’t become apparent that people were displeased until my popularity rose. That same year, I was elected school queen and “Student of the Year” by my peers. I saw the faculty sneer and heard the comments.

“Why him of all people?”

“How does it look?”

“What is she thinking?”

“Someone should talk to her.”

My world view began to shift. After all, these adults were my role models, instructors, and mentors. How could my choice in companion make such a huge impact on their perception of me? Their behavior led to cognitive dissonance in this young mind. As a result, I skipped prom to go on a date with him. TUH! That’ll show ‘em! Teenage logic is so wrong, but it seemed so right at the time. When the new high school queen was announced at prom, I was nowhere to be found. They panicked and called the authorities and MY PARENTS! I was mortified. Of course, everyone blamed him as a negative influence when it wasn’t even his idea. The truth is, his mom and stepdad took us to the movies to see Anaconda. We would have made it back unnoticed had I not “become popular” and required announcement at the prom.

This young man acknowledged me long before the crowd. To date, he is one of the most giving, protective and attentive guys I’ve ever known. Unfortunately, he has since passed away, but I think of him often. I reflect on the life lessons instilled in me from that experience:

1. We are often too consumed by the “book cover” that we don’t take time to read the content. This can occur in patient-provider interactions when assumptions are made based on ethnicity, gender, age or socioeconomic status. To do so is to cheat oneself out of the fullness and richness of an unbiased interaction. Also, these misperceptions can lead to misdiagnoses or improper and incomplete care.

2. Acting impulsively can have devastating consequences. If I could speak to my younger self, I would tell her not to skip prom because it would reinforce the fallacy of those adults’ message. Instead, I would instruct my younger self to challenge those myths with facts. In my career, I have witnessed some physicians’ socio-political commentary regarding patient care and watched interactions be marred by prejudice. Instead of attacking them, I listen respectfully and then respond with fact. Not all patients from that “certain neighborhood” respond a “certain way.”

3. Being in the spotlight has both perks and pressure. “To whom much is given, much is required.” The accolades are nice but admittedly, I haven’t always dealt with the pressure so well. Healthcare professionals are at higher risk than the general population for drug and alcohol abuse, depression, anxiety, and suicide. My sermon about self-care to my patients comes from a very real and personal place. Without it, the spotlight seems more like a heat lamp or frankly Hell. The ministry of healing is lost if first the physician is not kind to herself.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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*Cognitive dissonance, a theory described by Leon Festinger, is psychological terminology that refers to the inner conflict that arises when an individual is faced with information that contradicts core beliefs and values. #DrDeeMD

“Heartbreak Hotel”

“Give sorrow words. The grief that does not speak/ Whisper the o’er-fraught heart and bids it break.”

-Malcolm in Macbeth by William Shakespeare

Many people don’t know you can literally die from a broken heart. I will never forget a case during my intern year at Cooper Green Hospital. There was a mother admitted for heart failure. She had no history of coronary artery disease. She was not a smoker or drinker. Her high blood pressure was well-controlled with low-dose lisinopril. However, she had buried her only son just weeks prior to admission. That’s when I learned of a rare condition called Takatsubo’s cardiomyopathy.

In this condition, intense emotional stress causes the brain to release neurochemicals that cause coronary vessel spasm and abnormal heart muscle contraction. Truth is, as was the case for my patient, the heart failure is reversible with proper clinical support. However, I don’t believe her emotional heart ever normalized. It is such an unnatural thing for a parent to lose a child. As the adage goes, “children are supposed to bury their parents, not the other way around.” Still, the mind grapples with grief in remarkable ways and with proper emotional support, it can adapt to seemingly overwhelming loss.

Three major areas of the brain impacted by grief or loss include the parasympathetic nervous system, the prefrontal cortex/ frontal lobe, and the limbic system. As a result, those grieving may experience trouble eating and sleeping, difficulty with planning and task execution, as well as strong emotional responses to triggers that remind the person of the loss. The amygdala, a specific part of the limb system, causes us to run from these emotional triggers, which often prolongs the healing process.

It’s interesting how the coping mechanism used to numb the pain only depends the sorrow. To be isolated in grief is as devastating as the loss itself. This is why attending support groups is important to ushering in recovery and restoration. Doing so allows an individual to face the fear of grief with others who have gone through or are going through the same experience. Observing in others the various stages of grief (denial, anger, bargaining, depression and acceptance) is therapeutic. Although everyone deals with loss differently, support groups provide a road map of what to expect in general. Isolation allows the mind to remain in a state of confusion caused by stress hormones. However, a kind word or loving touch causes neurochemicals such as oxytocin to be released, which brings comfort in difficult times. That’s why counseling and support groups help the mind to adjust properly through confrontation and release of feelings that often hold its victim hostage.

How bereavement turns into clinical depression is thought to be linked to the brain’s loss of adaptability. Studies show that areas such as the hippocampus, which is linked to memory and mood, can produce new cells well into adulthood. However, the depressed brain loses the ability to generate new cells in this region.

We experience grief not only in bereavement. It can be felt with any major loss. More and more, patients are coming into the office primarily for an unrelated complaint and report depression and anxiety on review of systems. They are worried about rising insurance premiums, the cost of treatment, and the impact on their personal finances. People are concerned about their health or caring for an ailing parent and what this means for their own mortality. Patients are obsessed with local, national and international tragedies. They no longer feel physically, emotionally or financially safe. As a minister of health, my advice is usually the same:

1. Be patient with yourself. Allow time for your heart and mind to adapt to any major loss. Grief is a process that varies from person to person. Don’t judge your recovery based on another individual.

2. Surround yourself with positive people, those who support you wholeheartedly. Avoid isolation as it amplifies the pain even more.

3. Express your feelings in one form or another. Journaling, creative writing and psychotherapy are great ways to confront the hurt.

4. Meditation is good for the organic brain as well as emotional mind. Not only is it a great way to “check-in” with your internal milieu, but it actually allows brain to release natural antidepressant chemicals.

5. Trust the process. Emotions come like waves. Behavioral therapists teach patients means by which to bear the intense feeling until it passes. Such techniques include grounding and mindfulness. With time, the mind becomes conditioned to both endure the discomfort and begin to move forward. After all, what “they” say is true…”what doesn’t kill us DOES make us stronger.”

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Reference

· CNS Neurol Disord Drug Targets. 2014;13(6):930-6. “ Neurological aspects of grief”

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Definitions

· Grounding is a psychological technique designed to keep the person present in the moment. For example, when an intense feeling or thought arises, a patient is instructed to focus on a particular part of their own body, a sound in the room or looking at the detail of an item nearby. By doing so, it trains the mind to avoid following a traumatic stream of thought. This is a good technique because it can be done anywhere without those in the surroundings even knowing.

· Mindfulness speaks to being attentive in a purposeful manner and on a moment-by-moment basis. Here again, the idea is not allow emotion to overtake your thoughts and actions. Rather, it is the intention to focus on the present experience instead of the past. Meditation is an excellent way to execute this concept. #DrDeeMD

“I AM”

“When I discover who I am, I’ll be free.”

-Ralph Ellison Invisible Man

If someone asks you “who are you,” how would you respond? It’s kind of like the dreaded interview lead-in, “tell me about yourself.” During this open-ended discourse, the respondent often constructs his or her answer in order to appease the questioner. I may respond by saying, “I am the oldest of two girls, proud mother of one son, and an excellent neurologist.” From that statement, you would surmise that my family is of utmost importance to me, and I love what I do. Both are unequivocally correct. Still I didn’t answer the question. Instead, I identified roles in which I serve others.

Another way I might answer is “I am the oldest daughter of Liberian immigrants.” This reflects my proud heritage. Growing up as first-generation American with African-born relatives, I was often reminded of my “privilege” living in the land of opportunity. Meanwhile, to my neighborhood friends, I was the quiet African girl with the hard-to-pronounce name. This schism created torrent emotions about my identity during the teen years, already shrouded in its hormonal rage. Despite this dichotomy, my upbringing afforded me a unique world-view. Living in a real world Wakanda household made me feel invincible. There was nothing hard work and dedication could not accomplish. This complimented my realities as a Black American which taught me about endurance and resilience in the face of racism, discrimination and bigotry.

So, who is Decontee Musuba Jimmeh? To one, I am “Mommy.” To others, I am “Dee,” “Dr. Dee,” “Teesh,” and a whole host of nicknames too embarrassing to list. Those who know me best would say I prefer to lend to allure than fully divulge. Let’s just say this post is too short to answer the question thoroughly (WINK). Many people think of their identity as something they construct as opposed to an anatomical hard-wiring. Dr. Bruce Miller, a neurologist at University of California San Francisco was part of a 72-patient frontotemporal dementia study which identified that damage to the right frontal lobe can cause dramatic changes in a patient’s identity and self-awareness [Frontotemporal Dementia” Lancet 2015 Oct 24; 386 (10004):1672-82]. This is suggestive of identity as an anatomical construct. In contrast to the social media era where characters are feigned and created, the actual concept of identity is fascinating. While the quest toward self-discovery is an evolution, it is my belief that one’s identity is static. In other words, even though we transition to find out purpose and role in the universe, who we are is innately constant.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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*Frontotemporal dementia is a type of irreversible, memory disorder that is characterized by prominent behavioral disturbances, personality changes, problems with planning and task execution (associated with executive function disorder). This condition is more common in patients younger than 65 years of age. It is often confused with psychiatric disease because of the behavioral problems in previously normal individuals. #DrDeeMD

“BRING ON THE NOISE”

Illustration by Daniel Zender

“It is during our darkest moments that we must focus to see the light.”

-Aristotle Onassis

In college, I could never study in the library. Besides having uncomfortable chairs, it was just too quiet. Even now, while charting, it helps me to have some background noise. My preference is to type while listening to Power 105.1 Breakfast Club interviews. Joshua Rothman of The New Yorker discusses how Western society has used distraction to exert autonomy being “active and rebellious.” He postulates that we should embrace our “unfocussed selves” and that perhaps our diversions (i.e. social media) have become too predictable.

While the adverse effects of environmental noise on a person’s attention have been proven, some studies show that low noise or chatter helps the brain identify the most important information more easily. Moderate noise aids in creative thinking. Intuitively, it is easy to understand how noise could make it difficult to concentrate and process information. However, this distraction, in turn, promotes more abstract processing, sort of a “service road” or alternate route of thought. The extra work the brain has to do in order to circumvent the distraction boosts creativity.

This makes me think about life’s ambient noise and its effect on the spiritual mind. To be honest, I have been struggling to focus enough to execute certain personal and professional goals. It is like my worries won’t just “shut up!” These emotions won’t let me live. I keep telling myself “Girl, you have work to do!” It makes me think on the other side of this “noise” is an amazing breakthrough or discovery. During this time, it has become imperative to be still. The challenge is that in the quiet, feelings scream louder than ever. I am still learning to master the emotions and channel it toward creativity. Even here, it has taken me three days to write this short entry. Pardon the transparency. There is so much more work to do. I pray my mind sits perched just above the chaos to complete each task. If not, I’ll harness the noise and call myself a rebel.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.


References:

1. PLoS One. 2014 Nov 13;9(11):e112768. doi: 10.1371/journal.pone.0112768. eCollection 2014.

“Different effects of adding white noise on cognitive performance of sub-, normal and super-attentive school children.”

Helps SK, Bamford S, Sonuga-Barke EJ, Söderlund GB.

2. Nielsen, Emily G., “The Coffee Shop Effect: Investigating the Relationship between Ambient Noise and Cognitive

Flexibility” (2015). Electronic Thesis and Dissertation Repository. 3197.

3. Int J Environ Res Public Health. 2014 Oct; 11(10): 9938–9953.

Acoustic Noise Alters Selective Attention Processes as Indicated by Direct Current (DC) Brain Potential Changes

Karin Trimmel, Julia Schätzer, and Michael Trimmel *Paul B. Tchounwou, External Editor

“JUST MY IMAGINATION RUNNING AWAY WITH ME”

“Vision without execution is a hallucination.”

-Thomas Edison

Jean-Michel Basquiat (American, 1960–1988). Untitled, 1982. Acrylic, spray paint, and oil stick on canvas

Once I had a 90-something year old patient brought in by her granddaughter for evaluation after she kept hearing a threatening man yelling outside her window. After some investigation, the family discovered there was no man present despite the patient’s convincing account of events. The differential diagnosis in this population includes an array of possibilities from toxic, metabolic, or infectious disturbance to sundowning. When someone perceives a sensory input (e.g. visual, auditory, tactile) that does not exist, it is known as a hallucination. Commonly hallucinations are associated with psychotic people. However, normal subjects can hallucinate also. For example, sleep-deprived individuals, bereaved persons, and those in solitary confinement for prolonged periods of time can see and hear things that are not there.

The neurobiology of hallucinations is quite fascinating. In people with schizophrenia who hear voices, research using functional imaging has shown there is altered connectivity between parts of the temporal lobe, prefrontal region, and the anterior cingulate gyrus. In normal subjects, these areas would communicate in such a way that differentiate “self” from “non-self” stimuli. Whereas, in the psychotic person with auditory hallucinations, the ability to make this distinction is lost. Ever wonder why you can’t tickle yourself? Go ahead…I’ll wait. Blakemore and colleagues propose that the response to self-generated stimuli (i.e. tickling yourself) is dampened because we anticipate the response. In people with hallucinations from psychosis, this attenuation does not occur. Therefore, they not only lack insight that the stimulus is self-generated but they also often can’t anticipate the occurrence.
Cultural bias blurs the lines between visions, spiritual revelations, imagination, and audiovisual misperceptions. For instance, in various religions, it doesn’t seem bizarre to “hear the voice of the Holy Spirit.” In most cases, society distinctly views this experience different from a psychotic individual who hears the voice of God. Often, there is a context that makes differentiation clear. But what if it wasn’t that easy to tell?
From time to time, I am struck by a visual hallucination of the life I envision for myself. It can be as vivid as the words on this page. I imagine that if you put me in a functional MRI machine at the time of this image, parts of my occipital lobe and prefrontal cortex would light up. I picture an interwoven communication circuit between these areas. All the while, I am aware that the picture generated by my mind has yet to come to pass. I certainly want it to be so. In fact, I will it into reality. When I begin to question myself or become overwhelmed by the immensity of the vision, I return to my heritage in the form of African proverbs for practical guidance:

· Look for a dark goat first in the daytime because you may not find it at night.

o Meaning: Prioritize your goals before it’s too late to accomplish them.

· The best way to eat an elephant is to cut it into pieces

o Meaning: The greatest task is accomplished by taking one small step at a time.

· Maize bears fruits once and dies because it is not rooted in the ground.

o Meaning: Without a solid foundation, it is difficult to be prosperous.

· If you want to walk fast, walk alone. If you want to walk far, walk with others.

o Meaning: On this journey called life, having a sense of community will get you further by not only providing focus and purpose but also encouragement along the way.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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“The anterior cingulate gyrus is part of the medial frontal lobe responsible for decision making, emotional control and regulation of autonomic function (such as heart rate and blood pressure). The temporal lobe houses the hearing centers as well as the memory system. The prefrontal cortex functions in personality, complex planning, and attention. In particular, the prefrontal cortex helps individuals to process and prioritize simultaneous, competing stimuli. The occipital lobe carries the vision center of the brain.”

Image Credit: https://www.thinglink.com/scene/714175929814876161

References

1. Blakemore SJ, Smith J, Steel R, Johnstone CE, Frith CD. “The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring.” Psychol Med. 2000 Sep;30(5):1131-9. 2. Boksa, Patricia. “On the neurobiology of hallucinations.” J Psychiatry Neurosci. 2009 Jul; 34(4): 260–262.

“For Stephanie”

“The elephant does not limp while walking on thorns.”

-Ethiopian Proverb

On July 2nd, this world lost a valuable person. She w

 

as my friend, sorority sister, and colleague. She loved her family, served her community and treated patients with dignity and respect. Throughout her health journey from diagnosis to transition, she continued witnessing to others through online journal entries, demonstrating strength and vulnerability in a way only a beautiful soul could balance. Even though her body was waging war, she would check on my mother’s progress when she was ill. That was her way, still caring for others in the midst of her own affliction. I admire her. I miss her. My peace comes from knowing she is now resting.

During my residency training, when she saw a mixture of fatigue and frustration on my face, she did not hesitate to reassure me that I could make it through. Both proud alumnae of Xavier University of Louisiana, we both are accustomed to the “each one reach one” pipeline of excellence. As success was afforded us, we understood it as our duty to mentor others along the way. Now post-training, her greatest tutelage of me was her commitment to live life fully to the very end. At the memorial service, those who knew her best rejoiced that the service was conducted just that way she wanted. May those who remain behind live life much like the ceremony…mostly laughter, some reflection and little jazz to top it off. #DrDeeMD

 

Donate to the Dr. Stephanie Hightower Memorial Scholarship

Read The Mineral District Medical Society’s Resolution for Dr. Stephanie Hightower

 

A Long-Distance Relationship

“A platform does not make you…it only reveals you.”

-Pastor John Gray

Absolute statements can be dangerous. Long distance relationships NEVER work. Once the haze of absence-made affection dissolves, the reality remains that the immediate needs of both partners are often left unmet. Many feel these couples become arrested in the so-called “honeymoon” phase. Always excited just to see each other, they don’t get to witness the full picture of the other person without the dopamine rush of infatuation. While most view long-distance relationships as unrealistic, some find them invigorating, intoxicating and worth the risk. Surprisingly, statistics show that only about forty percent of long-distance relationships fail. Evidence reveals that these couples often have better communication. A 2017 study published in the Journal of Communication* found that “[people] in long-distance relationships were more likely to share meaningful thoughts.” This, in turn, improves perceived intimacy between partners.

Now before I go any further, let me clarify. Dr. Dee is not a love doctor. However, it is my experience that “distance” in some relationships can be healthy and appropriate. Allow me to elaborate…American businessman Eli Broad stated, “I’d rather be respected than loved.” While most prefer both, the statement appropriately establishes respect as the priority. This has been a tough but lasting lesson for me. Naturally relatable, it is easy for younger staff members to both find me approachable but also take me for granted. Meanwhile, older staff may disregard my instruction, mistaking youth for inexperience.

On top of all the responsibilities a physician holds, managing interpersonal relations in the clinical setting is among the most challenging. This is because for a practice or system to run effectively, all members must work in concert. Sounds simple right? Well, pardon the colloquialism, it ain’t! Attitudes, preconceived notions, and personalities clash constantly, causing work not to be done. Here’s an example:

Staff person X (age 25; medical assistant for 3 years)
Staff person Y (age 54; registered nurse for 30 years)
Dr. Z (age 35; 9 years in practice)

  • Dr. Z is requesting an important document to be faxed regarding patient care.
  • Person X asks person Y to fax the document for Dr. Z’s patient.
  • Person Y is offended because Dr. Z did not ask personally and in general doesn’t like “taking orders” from other staff, especially younger or subordinate ones.
  • RESULT: The task is not completed.

Earlier, in my training, my approach was to be chummy with staff, which had its advantage. In general, they wanted to do their best for me. However, the burden of familiarity tends to tip the scale toward disrespect. As I evolved in my title, a healthy “distance” became necessary not only to establish and affirm the hierarchy, but also to improve communication and clearly set expectations. Boundaries can and should be maintained without the air of arrogance. If it is my true nature to be humble, the pulpit of doctoring should reflect so even more.

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Dr. Dee is a board-certified neurologist with specialty training in clinical neurophysiology committed to educate the community on how to live more healthy lives.

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*Reference

1. L. Crystal Jiang, Jeffrey T. Hancock. “Absence Makes Communication Grow Fonder: Geographic Separation, Interpersonal Media, and Intimacy in Dating Relationships.” Journal of Communication, 2013; 63 (3) 556-577.