In this episode of the Brain & Life Podcast, Dr. Daniel Correa and Dr. Katy Peters discuss the nuances of holiday planning, the importance of family time, and recognizing early signs of neurologic conditions in loved ones. They also explore the benefits and considerations of hot yoga, and share personal resolutions for the New Year, focusing on flexibility and dietary changes. Explore the articles featured in this episode and more.
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Articles Mentioned
- Learn to Recognize Early Signs of Neurologic Conditions in Loved Ones During the Holidays
- Four Ways to Manage the Holidays When a Loved One Has a Neurologic Condition
- Is Hot Yoga Safe? Neurologists Weigh in on Risks and Benefits
Other Brain & Life Episodes on These Topics
- Navigating Complicated Caregiving Journeys with Jacquelyn Revere
- Thriving in the Kitchen with Chef Dan Jacobs
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- Hosts: Dr. Daniel Correa @NeuroDrCorrea; Dr. Katy Peters @KatyPetersMDPhD
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Episode Transcript
Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.
Dr. Peters:
And I am Dr. Katy Peters. And this is the Brain & Life Podcast.
The holiday season is so fast approaching. It's upon us right now and I'm trying to rationalize if I want to celebrate Christmas or Festivus. Just joking. I'm now on track to start planning for Thanksgiving. My husband gets me in line because I even have a Thanksgiving dossier. We have our heritage turkey that we'll pick up at a local farm-
Dr. Correa:
Ooh, fancy.
Dr. Peters:
... in [inaudible 00:00:46]. Yeah. Yeah. Those local farmers are so important and I was just discussing a new riff with him last night on my traditional cornbread stuffing, maybe using potato gnocchi instead for stuffing.
Dr. Correa:
I don't know about that.
Dr. Peters:
I don't know.
Dr. Correa:
You've been pretty controversial there.
Dr. Peters:
I know. One time my mom did this whole pesto thing at Christmas with like... I think it was veal chops, and people were like, "Where's the ham?" You can't deviate too much, but are you starting to plan Thanksgiving?
Dr. Correa:
Normally I would've. And I have to say, I thought we were going to start with some singing or something from you there, but no, I'm usually such a cooking nut that I also have a whole... All of these things laid out. I have notes from past Thanksgiving menus that I had and often checking in with my family, the things that they're interested in having. I usually like to have classics with little riffs or extras, maybe a slightly different sauce. I tend to have a chimichurri also along with the cranberry sauce at the table because I like that variety. But yeah, and also I like cooking so much I kind of plan out the days so that I can cook more than half of the dishes.
Dr. Peters:
Yeah, I know. I have a dossier. It's a checklist.
Dr. Correa:
Admittedly, I'm way behind. This year after my family and I have been dealing with the loss of my sister.
Dr. Peters:
I'm so sorry.
Dr. Correa:
We're not, I think, ready in the same way that we have. But we are glad to be together and sharing. And so I'm behind on that checklist, but I think I'm working on the personal checklist of approaching the holidays and their challenges but acknowledging the important thing is that we're together to celebrate our time as family throughout the winter holidays.
Dr. Peters:
And that's all what the holidays about. And again, I'm so sorry and I'm so glad that you will have an opportunity to get together with your family and be with them and support each other and think about all the things we can be thankful for. And I'm thankful for you and I'm thankful to our wonderful listeners and thankful for our wonderful magazine and all of our wonderful article highlights, which is what we're going to discuss today.
Dr. Correa:
And the amazing resources through the magazine website and the expanding website. It's great to be able to take a look at, so I'm excited yes, for this what's coming out in this edition and in this article. So Katy, what were some of the things that stood out for you?
Dr. Peters:
So in this first article, it's entitled Learn to Recognize Early Signs of Neurologic Conditions in Loved Ones During the Holidays. This article explains that holidays often reveal early signs of neurologic conditions because you're actually spending more time now with your relatives. And so it's actually a phenomenon that I believe we've seen in medicine when we're on call. And I remember I used to be on call every Thanksgiving. People would come in and be like, "We haven't seen grandma like this." And I was like, "But you also haven't seen grandma," so there's a lot that can happen.
So experts note that you could sometimes see confusion, memory lapses, balance issues or mood changes that could signal maybe something else is going on. Could this even be early Alzheimer's? Could this be a movement disorder like Parkinson's? And I think when I think about this phenomenon, I can just imagine our senior family members, we usually are going back to their homes. They want to cook for us, they want to wrap the presents. They may even want to clean things their own way. So you might notice things that there were tasks that were much easier for them before are now they're struggling with those familiar tasks and maybe they have some memory loss, maybe some weakness, maybe loss of balance, or maybe you might notice that during the holidays maybe their mood is changing, maybe their behaviors are changing, maybe they could even look a little different.
Dr. Correa:
Yeah, I think it's important also to just remember and to think about and even notice or ask with your family member, there can be so many other stressors. Of course, we have the blessing of that family time together, but as you talked about that extra time, cooking, cleaning, preparing the house, the change in routine in the house, they may not be sleeping as well. There's lots of other things, both their activity level and sleep and those schedules can be disrupted and they might be bringing out symptoms that are of concern or some things might actually get temporarily worse just because of those added stressors. And doctors recommend observing and recording those symptoms like in many other situations. But in this situation, now that you're together with your family member more.
And you might think about discussing them with a loved one, but bringing up the topic directly in terms of what you see with the affected person could lead to defensiveness so involving others or communicating together as a family or when needed, maybe thinking about communicating privately with their doctor might be more effective. But I think in terms of bringing up the questions or concerns that you have with a family member, maybe sometimes less on focusing on the specific symptoms, memory issues, losing the keys or so on. But really to ask maybe more the question about the kinds of changes they've been noticing and the things that they're doing around the home, how different things their memory or any other changes in their routine and pattern has impacted the things that are important to them.
And then arranging for a medical visit soon after those concerns arise and you have had some of this discussion, but center the focus and the discussion with the doctors and with your family member around what matters to them most, the parts of their life and activities that have been affected, centered around what they are noticing and what they want to do better, what they want to improve in and less on like, "Oh, we're pointing out that you are not doing this," or, "You're losing capability." And a lot of times then there's an anchoring on, "Oh no, I want to protect my independence or access."
Instead of saying, "Let's see if there are ways we can get you back to some of these activities or doing them more safely." And when greater care is needed, then a lot of the experts suggests introducing help gradually so there isn't such a huge disruption in routine, starting with some limited hours and simple tasks of the different ways that people either within the family or other help is coming in to assist them because resistance can be very common, but support from social workers, aging agencies, support groups can really help that transition both for the person and their family, but most of all, families should act early as waiting too long could worsen safety or health risks and you might miss out on an opportunity for some things that are very reversible. We often will find when people come in, the first thing we do is we test and look for all the things that could be temporary and reversible, whether it's an infection or something that's off on the hormones or vitamins because those we can fix and aren't necessarily a long-term progressive issue.
Dr. Peters:
One of the things I sort of thought about when I was reading this article is we go to visit our loved ones during the holidays and it can be sort of an emotional time potentially for people. It can be a crowded time, a lot of people there. So I think you really need to see how they day to day, maybe not on a holiday season. So I think all in all, we need to probably see our loved ones more and think of them not just on the holidays but completely year-round to see how their living situation is. Because those holiday findings may lead to the tough conversations that you just described, but we probably need to be having those long-term and all along.
Dr. Correa:
Yeah. And so this article talks about early signs of a neurologic condition and starting to have the discussion, notice some of the symptoms and maybe you don't know if it's neurologic or not, but it's just a change in function. Another article that I find very helpful and if this interested you also to think about navigating the holidays through the Brain & Life Magazine is for those who live with a known and diagnosed neurologic condition. And in that article they talk about four ways to help manage and approach the holidays when a loved one has a neurologic condition. So we won't restate all the aspects there, but I think it's another one that's really good online and in the print issue that you should check out and helps that for that discussion for those of us who live and support with a loved one who is living with a neurologic condition.
Now Katy, was there another article that caught your attention and that you're thinking about for the winter holidays?
Dr. Peters:
So I actually leapt all over the December holidays and went straight to New Year's Day and sort of are having to make some resolutions for good exercise behaviors and that article is entitled, Is Hot Yoga Safe? Neurologists Weigh in on the Risks and Benefits. And so I've done hot yoga twice. Twice. It is a practice where the room is heated up. I've never sweat so much. It was so hot. They heat it up to about 105 degrees Fahrenheit. It can be a 90 minute session of intricate poses. You're supposed to really get into the poses.
And it's pretty popular. About a third of us yoga practitioners engage in hot yoga and they really say it helps focus. You're able to get into poses better. You can have increased flexibility, increased balance, but it's all about getting into those poses and maybe if you're heated up, do you relax your muscles more? And so yoga has been touted as being wonderful for improving physical health and also your brain health, also reducing your anxiety and depression and also have better psychosocial outcomes, also better cardiovascular, musculoskeletal function. Daniel, have you sweated to the hot yoga? I don't even know what to say.
Dr. Correa:
Yes, I have dipped in all body and full of sweat into hot yoga. Yoga itself, I like. I enjoy it as an activity. Sometimes I'll go to a class. More often when I'm feeling tight and sore from some of the other activities and exercises that I do, then I'll pop on a YouTube video of a 10 to 30 minute class and I'll do some yoga at home to help me with guided stretching. I'm not that great at doing stretches much on my own, so that's why I like the pattern of doing yoga classes on my own and I really enjoy the experience that I've had going when I'm really tight and just needing really that looseness that the effect of yoga and then hot yoga has had for me. And in fact, studies have shown that the non-hot, just the regular yoga, can improve quality of life for people with epilepsy by lowering anxiety and perceived stigma of their condition along with benefits that have been shown in other conditions.
Hot yoga specifically can improve flexibility and strength. It itself is a strength exercise and that warmth helps through the range of motion of your muscles and arms. It's important to also just be aware of because that warmth is loosening up that joint, you're just moving through the range and not pushing yourself too extremely. You don't want to pull something just because you got warmed up. And it may not be suitable for someone or everyone since it can have some effects on blood pressure and heart rate in terms of general medical issues.
But there are people with neurologic conditions who should consult their doctor before starting. And among those neurologic conditions, a hot yoga may be unsafe or require some more assessment before people who have multiple sclerosis, autonomic dysfunction. That includes POTS and myasthenia gravis or have medications that might affect your heat or sweat regulation like Topamax or topiramate that some people take for migraines or seizures. So these are important considerations, but I think it's something for people to think about if we're looking for ways to move more in the new year, yoga and if you're feeling safe, you don't have a concern then trying out hot yoga or other types of movements, I think what's important is the time moving. What about you, Katy?
Dr. Peters:
So I'm actually going to put you on the spot, Dr. Correa. How do you feel about your epilepsy patients doing hot yoga versus regular yoga?
Dr. Correa:
So if they're not taking Topiramate or Zonegran, which is another medication that both affect sweat production, then I wouldn't have as much concern. Again, I would have a conversation with them to make sure that they haven't had episodes that affect what looks like their autonomic system as either before their seizures or after. It depends on the type and cause of their epilepsy. Some people have genetic causes that might be a little bit more concern or maybe if the cause of their epilepsy was after a stroke or a hemorrhage, then often that's going to be overlapping with blood pressure issues and stuff. So I often say I wouldn't necessarily start with hot yoga. So have you already been doing yoga and feel very comfortable with it and comfortable with the activity, the exercise, the classes, know it and had a chance to listen to how your body responds to it, even doing a challenging class and then seeing if that's the case.
And the next thing you want to add to that is trying out hot yoga. Then also being aware of... And some places to start with that there is maybe starting with is it safe for you to go into a sauna? And if it's safe for you to be in a sauna and or we've screened and we don't have as many concerns and you can tolerate being in a sauna for 10 to 15 minutes, then it's a different setting if you're then also going to be doing exercise in this elevated heat setting.
Dr. Peters:
Yeah, I agree with you. I don't think it should be the first exercise you try. And for my patients with brain tumors. And it's usually because of the concomitant medications, like the anti-seizure medicines. Or we don't want them to be dehydrated in the setting of them already being on chemotherapy. Also, a situation with being on also steroids associated with an increase in blood pressure. I tend to not be the first exercise... Actually the number one exercise I tell them to avoid is boxing. But hey, [inaudible 00:16:40] so usually that's my first.
I actually in general encourage exercise and encourage movement and want our patients to remain frisky. I think that hot yoga, you can find maybe some softer alternatives. You can consider things like chair yoga, gentle yoga, restorative classes, tai chi, something that's in a cooler environment potentially. I do think that there's an appeal to it and if you want to gradually move up to it, as long as you're being monitored and I think being in a class is really important. I think that if they want to do this, being with an instructor that's certified and knows that they're doing and has had different types of patients in their class, but I'd say in general, I'm always going to recommend exercise, maybe just change the type or don't go straight to hot yoga, but consider other forms first.
Dr. Correa:
Now Katy, you brought it up. You said skipping ahead to New Year's and making resolutions and we were just talking about activity and exercise, but is there something you're thinking now or are you sort of mulling over of what you want to work on or set as a goal for yourself in the new year?
Dr. Peters:
I think you actually had a magic word in what you discussed is you mentioned stretching and flexibility. I really tried in 2023 I would say to really try to do more stretching. 2024, I fell behind and I blame moving. So I'm going to say for I'd say 2024 and 2025, I sort of fell behind. So I'd say 2026 is the year of the stretch. I'm going to be limber again. You will not recognize me in the splits. I'm just joking. So I'm going to say to be more flexible and I would say that I'm going to use flexibility as a... Across the board also to be more flexible in my life, more flexible in situations. I find that we all have goals and desires and sometimes we can be so goal-driven. It's okay to swerve a little bit. So I said to be flexible in all parts of my life. What about you?
Dr. Correa:
I like that. I think flexibility in all aspects of our life is, I think, a great positive. And I am thinking about and working on being more flexible in my diet and in that what it is that we're so much more evidence coming out about the benefits of brain-healthy diets and plant-based diets, and so I'm already many days of the week eat vegetarian meals, probably two of my meals a day and have maybe something, some meat or dairy at other points of day. I think dairy will be the hardest thing to give up and I'm not going to start with there. I might not necessarily ever give up dairy for me, but I'm actually looking at trying to have maybe one or two more days in the week where it's actually a fully vegetarian day and have more days when I'm thinking of having meat, especially at home because my wife would love it if we actually ended up moving more vegetarian.
Thinking of meat as being... Other than fish, as the second or third option when I'm thinking of what to make for dinner and seeing if I can make more choices towards non-processed plant-based proteins and more veggies and just kind of increase the volume of those. I don't know if it's going to work for me necessarily to go full-on vegan or vegetarian, but just as much as often and as I can, I figure I'm trying to see if I can set myself up in 15 years to thank Daniel of 2026.
Dr. Peters:
I totally agree. Can I add something in there?
Dr. Correa:
Oh, yeah.
Dr. Peters:
I think that if you're thinking about dietary flexibility and things to add in, I think one of the things that we forget when we're younger is really how important fiber is. You have to have a concerted effort to do that. But actually starting in the summer, I essentially told myself I had to eat a whole piece of fruit every day before I ever had any kind of dessert or sweet thing.
Dr. Correa:
Well, thankfully I'm pretty good in that. I'm nowhere near necessarily the social media fiber-maxxers that are out there, but I have at least one or two pieces of fruit a day. I have a good amount of veggies. I'm usually adding chia or flaxseed to some either overnight oats or some meal or some point in the day so that as I was kind of looking over and thinking of, "Where can I improve but still really focus on cooking really delicious things?" [inaudible 00:21:38] okay.
I sort of default as many of us have from growing up to thinking about, "Oh, I want to make chicken. I want to make..." Sort of starting with the meat protein as the part of what I'm cooking on and I'm thinking of trying to start first more with planning the beans that I'm going to make and planning the veggies and seeing if I can think of and plan a whole meal that feels fulfilling that doesn't have meat, and just do that more often as the first or second choice. And if not, and I'm really hungry or leave the occasional little treat of going out to eat something or something like that, then okay, "Well now since I'm out, maybe I'll have something that's a little bit different or a cuisine where I'm not as familiar with picking the vegetarian dishes so easily."
Dr. Peters:
I'm going to support you in this. I'll send you some lentil recipes.
Dr. Correa:
Ooh, I'm looking forward to that. Yes.
Dr. Peters:
Yeah, black lentils. [inaudible 00:22:38] black lentils.
Dr. Correa:
Yeah. No, and I've been looking for more recipes. I'm looking towards, "Oh, okay." The cultures that I really enjoy going out to eat restaurant-wise or cooking some at home and instead, "Well, okay, I'm going to look up Buddhist Asian recipes instead of the ones that are centered around meat." Look at some of the vegetarian Caribbean recipes and try out those and explore some of the flavors and spices and everything that I like, but just with different alternatives.
Dr. Peters:
So I actually think now I know your Christmas present. I know what I'm going to send you. I have a really good cookbook that's vegetarian that is a staple in my kitchen, so I can't wait to send it to you, but I'm not going to tell you what it is because it's going to be a surprise.
Dr. Correa:
Well, thank you all for joining us. We hope you enjoy these holidays. Let us know if you have other questions, if you have ideas, if you have suggestions even for us in what we're working on or thinking of for our new year or for the holidays, please reach out.
Thank you again for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life magazine for free at brainandlife.org.
Dr. Peters:
Also for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org and leave us a message at (612) 928-6206.
Dr. Correa:
You can also find that information in our show notes and you can follow Katy and me and the Brain & Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online @NeuroDrCorrea.
Dr. Peters:
And Dr. Katy Peters joining you from Durham, North Carolina and online @KatyPetersMDPhD.
Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.
Dr. Peters:
We hope together we can take steps to better brain health and each thrive with our own abilities every day.
Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain & Life Podcast. See you next week.
