'A doctor's Dozen'

“A Doctor’s Dozen: Twelve Strategies for Personal Health and a Culture of Wellness”

By Catherine Florio Pipas

Dartmouth College Press

222 pages, $24.95

After her residency at The Medical University of South Carolina, founded in 1824 in Charleston, Dr. Catherine Florio Pipas spent 25 years in a family medicine clinical practice. She is now a professor of community and family medicine at Geisel School of Medicine at Dartmouth College.

Her interest and expertise combine personal health and wellness with community engagement and population health.

In her cordial book, “A Doctor’s Dozen: Twelve Strategies for Personal Health and a Culture of Wellness,” Pipas’ underlying emphasis is “Self-Care,” which begins with self-awareness and leads to self-improvement. This compendium of case studies is drawn largely “from patients and colleagues on my own journey toward wellness and quest to promote health and self-care in others.”

The setting is her office, where she has learned these lessons of wellness up close and personal. Each of the lessons (“strategies,” she labels them) can be applied to advance the pursuit of an individual’s health.

First, the good news. Achievements in research, public health, medicine and medical technology have led to a 30-year gain in life expectancy between 1900 and 2000. Advances in vaccines, antibiotics, safety policies, education about tobacco, reductions in tuberculosis, diphtheria, pertussis, polio, hepatitis, lead poisoning and cervical cancer have been significant.

Extending average life expectancy today in the United States starts at 79 years of age. Extending life expectancy to 150 by the year 2250 requires changing personal behaviors. The World Health Organization estimates that by 2020, two-thirds of all causes of death worldwide will be the result of lifestyle choices. Pipas writes that living longer creates a paradox, requiring all of us to take better care of ourselves over a longer period.

“Addressing threats to health and promoting healthy habits such as an active lifestyle, healthy diet, and routine sleep are vital,“ she writes. Changing high-risk behaviors is critical. These include quitting smoking, reducing substance abuse, practicing safe sex, and managing chronic stress.

WHO defines health as “complete physical, mental, and social well-being, not merely the absence of disease,” Pipas writes.

Physical health, she stresses, “includes realizing that cardiovascular disease and cancer are largely due to preventable behaviors, such as a sedentary lifestyle, poor diet, and tobacco use. Obesity is a growing epidemic, and tobacco is viewed as public health enemy No. 1, responsible for half of all cancers and over 70 percent of all deaths.”

Other “healths” she defines as important to overall maintenance ranges in wellness from physical health, spiritual health, emotional health, social health, intellectual health, occupational health and environmental health.

Pipas weaves in stories of her own patients, many of them with cancer, such as a woman she named Hannah. For nine years, Pipas cared for Hannah. During this time, Hannah told Pipas, “It was the cancer that made her mindful and taught her and her family to focus on what mattered: ‘Cherish each day as if it is your last.’ ”

For four years her medical scans were normal. But cancer gradually won out. Pipas writes that in her final office visit, Hannah shared a new mantra: “ ‘Cherish each moment as if it is your last.’ ”

“I never saw her again,” Pipas writes. “Hannah died on December 15, my birthday.”

Mindfulness, Pipas continues, “has been defined as people’s ability to be purposefully and non-judgmentally attentive to their own experiences, thoughts and feelings.

Jon Kabat-Zinn, founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School, describes it as a “waking up and living in harmony with one’s self and with the world.”

Mindfulness is synonymous with meditation, which has philosophical and spiritual roots dating to before Christ, before Buddha and even before Aristotle.

Pipas writes, “I used to run from one task to another, proudly multitasking along the way; the concept of focusing on one thing was foreign to me. I first discovered the benefits of mindfulness in a yoga class I took prior to attending medical school. Simple calming words directed my attention away from work, away from future plans, and toward the present moment.”

Gone with the wind went the flurries of her thoughts: “I would run in D.C. and miss the Washington Monument, run along the Maine coast and miss even the ocean. I would eat and not remember what I had eaten or even that I had eaten.”

She takes Buddha Monk Nhjkat Hanh’s words to heart: “It is ridiculous to say, wait until I finish this, then I will be free to live in peace. What is this? A diploma, a job, a house, the payment of a debt? If you think that way, peace will never come. There is always another ‘this’ that will follow. If you are not living in peace at this moment, you will never be able to. If you truly want to be at peace, you must be at peace right now. Otherwise, there is only the hope of peace someday.”

Pipas places her mindfulness discoveries up front in her book and then explains the reason: “I took the Day of Mindfulness challenge. I found Sundays, my chosen day to be peaceful, replenishing, and surprisingly productive. I began using reflection before studying, and I felt the same intensity for physiology as for yoga. Addressing one task at a time, I again found joy in learning. The pressure and fear subsided. Since then I have assimilated mindfulness while running, cooking, walking in the woods with my husband, talking with my daughters, attending budget committees, facing fears, and listening to patients. Being in the moment changed my perception of mindfulness from a ten-minute exercise to a way of living.

“My life as a physician, mother, teacher, and wife often distracted me from being present now. Hannah retaught me. The greatest gift we have to give is our time and attention, and the time to be attentive is always now. When we devote time and attention to something or someone, including ourselves, we declare what matters to us.

“By being in the now, Hannah diminished past worries and future fears. Focusing in the moment simplified her life by freeing her senses to observe only current details. To focus is to limit distractions and attend to a priority fully. Hannah told me that she found moving mindlessly from one thing to another was preventing her from accomplishing anything.”

The goal is not perfection. “Instead,” Pipas writes, “the goal is continual personal growth and development. As I reflect on the lessons, strategies, and stories included here, I continue to observe myself and others, ask questions, reflect on my resilience, and journal my story. I am grateful as I strive for balance in eating, sleeping, exercising, and preserving time for others and myself. I am thankful even when struggling, as I am prompted to pursue authentic and healthy choices; change my thoughts, feelings, and actions; and celebrate that which is positive in my health and my life.”

Quoting Euripides, Pipas writes, “There is just one life for each of us: our own.”

Steve Sherman reviews books related to New England by subject or author on alternating Sundays. Submit newly published books and a news release to The Keene Sentinel, 60 West St., Keene 03431.