Understanding Cardiac Arrest, Heart Attacks, and the Power of Mental Health

100:00:00,480 --> 00:00:02,404Speaker 1: Welcome to the Healthy, Wealthy and Wise 200:00:02,524 --> 00:00:08,064podcast with Dr William Chokta, MDJD. Our mission is to empower 300:00:08,125 --> 00:00:11,897you with the knowledge and the tools you need to thrive in all 400:00:12,099 --> 00:00:16,184aspects of your lives. Join us now as we discuss everything 500:00:16,285 --> 00:00:19,823from nutrition and exercise to money management and personal 600:00:19,862 --> 00:00:24,733growth. Dr Chokta will provide insightful advice on how to 700:00:24,774 --> 00:00:28,064improve your physical and financial health, as well as 800:00:28,103 --> 00:00:31,460your emotional and mental well-being. Whether you're 900:00:31,481 --> 00:00:35,930looking to boost your energy levels, unlock financial freedom1000:00:35,930 --> 00:00:40,228or cultivate a more positive mindset, we've got you covered. 1100:00:41,880 --> 00:00:45,901Get ready to become the best version of yourself? So let's 1200:00:45,941 --> 00:00:50,329get started. Here's Dr William Chokta, MDJD. 1300:00:51,240 --> 00:00:54,601Speaker 2: Welcome to the Leadership Masterclass. We're 1400:00:54,621 --> 00:00:56,948going to talk about cardiac arrest and heart attack this 1500:00:57,029 --> 00:00:59,902morning. We're delighted to haveyou with us, so let's get 1600:00:59,942 --> 00:01:04,820started. I believe life is aboutbeing of service to others. I 1700:01:04,881 --> 00:01:08,605believe knowledge is power. I believe leaders can change the 1800:01:08,644 --> 00:01:13,349world. Today we're going to talkabout a very important topic 1900:01:13,540 --> 00:01:16,441And, as always, i'd like to giveyou an outline. The outline 2000:01:16,481 --> 00:01:21,004lets you know what we're going to talk about, and the other 2100:01:21,043 --> 00:01:24,531purpose of the outline is to letyou know that when we're just 2200:01:24,570 --> 00:01:28,533about done. So first I wanted, as always, to suggest to you 2300:01:28,593 --> 00:01:32,822let's do what to have you think like doctors, and if you think 2400:01:32,921 --> 00:01:36,838like doctors, then some of this stuff will make sense to you as 2500:01:36,899 --> 00:01:40,823we go through this presentation.Next, we're going to talk about2600:01:40,823 --> 00:01:46,022the common causes of death in this country. Take a distinction2700:01:46,022 --> 00:01:50,371between cardiac arrest and heart attack, and we'll end with2800:01:50,371 --> 00:01:53,007a discussion about cardiopulmonary resuscitation. 2900:01:53,519 --> 00:01:57,388So by the time we start talking about CPR, you know that I'm 3000:01:57,430 --> 00:02:00,665just about done. I realize that you're very busy people and 3100:02:00,685 --> 00:02:05,465we're absolutely delighted to have you join us on this journey3200:02:05,465 --> 00:02:10,460and to spare some of your very valuable time with us. The most 3300:02:10,501 --> 00:02:13,967common cause of death in this country are heart disease, 3400:02:14,329 --> 00:02:19,140cancer and trauma. Heart disease, cancer and trauma. We're going3500:02:19,140 --> 00:02:22,068to concentrate on heart diseasefor the time that we have 3600:02:22,128 --> 00:02:26,606together And we can divide heartdisease into two main areas, 3700:02:26,787 --> 00:02:30,883the most serious parts of heart disease, and that is heart 3800:02:30,962 --> 00:02:35,165attack and cardiac arrest. Now, you've heard of both of them, 3900:02:36,509 --> 00:02:40,080but we're going to break it downto distinguish between the two,4000:02:40,080 --> 00:02:44,521because sometimes people get them confused. So let's talk 4100:02:44,562 --> 00:02:49,550about heart attack. Heart attackis when. Well, let me back up, 4200:02:49,931 --> 00:02:53,967the heart is a muscle that sits in the middle of the chest and 4300:02:54,027 --> 00:02:56,959is connected through the other parts of the body through very, 4400:02:57,019 --> 00:03:02,169very large blood vessels. The heart basically works by having 4500:03:02,289 --> 00:03:06,762blood supplied to it, to those muscles, so that those muscles 4600:03:06,842 --> 00:03:11,856can pump regularly and efficiently to move blood around4700:03:11,856 --> 00:03:15,141to all the different parts of the body. So it's a very, very 4800:03:15,222 --> 00:03:18,229important part, a very, very obviously important organ in the4900:03:18,229 --> 00:03:24,556body, and to do that, the heartmust be supplied with the blood5000:03:24,556 --> 00:03:28,205, supplied through what's calledthe coronary arteries, or the 5100:03:28,326 --> 00:03:31,643heart arteries, if you will. These arteries. They go 5200:03:31,683 --> 00:03:36,598throughout the heart and they supply the muscle with oxygen, 5300:03:36,639 --> 00:03:40,247with blood, through red blood cells. That allows it to do its 5400:03:40,366 --> 00:03:44,581work and pump the blood throughout the body. So a heart 5500:03:44,622 --> 00:03:49,631attack in essence means that there is a blockage, either 5600:03:49,691 --> 00:03:54,367complete or partial, of those arteries that supply blood to 5700:03:54,407 --> 00:04:00,229the heart. Let me say that againa heart attack is a blockage, 5800:04:00,429 --> 00:04:04,562partial or complete, of those arteries we call them coronary 5900:04:04,663 --> 00:04:09,484arteries that supply blood to the heart. And what happens is 6000:04:09,544 --> 00:04:13,497that as that blockage becomes more and more and more complete,6100:04:13,497 --> 00:04:18,314less and less blood gets to theheart muscles. The heart then 6200:04:18,374 --> 00:04:23,307cannot function as it normally should and a heart attack may 6300:04:23,348 --> 00:04:29,682very well ensue. So but we were always taught And this dates 6400:04:29,742 --> 00:04:31,949back to what's called the Fremenheim study, which is many,6500:04:31,949 --> 00:04:36,500many years ago I graduated frommedical school in 1973. This is6600:04:36,500 --> 00:04:40,365long before that But basically the Fremenheim study told us 6700:04:40,846 --> 00:04:44,321that when someone is having a heart attack, they would have 6800:04:44,661 --> 00:04:50,194the primary symptoms include a crushing substernal chest pain 6900:04:52,237 --> 00:04:57,708that radiated to the left arm, acrushing substernal chest pain,7000:04:57,708 --> 00:05:01,228a pain in the middle of the chest that was very, very hard, 7100:05:01,327 --> 00:05:05,786very, very strong, and that thenradiated, or moved, if you will7200:05:05,786 --> 00:05:09,783, around and down the left arm. Occasionally it could be 7300:05:09,822 --> 00:05:12,891associated with nausea. But the crushing substernal chest pain 7400:05:13,319 --> 00:05:19,913was absolutely a major factor indiagnosing this particular 7500:05:19,952 --> 00:05:23,511condition And that it usually occurred in men, usually in 7600:05:23,531 --> 00:05:27,244middle age, the elderly men sometimes, who were slightly 7700:05:27,404 --> 00:05:31,971overweight, and that obviously was important to get these 7800:05:32,031 --> 00:05:34,261individuals to a hospital so they could be treated 7900:05:34,322 --> 00:05:41,476immediately. So in effect, the heart attack is basically a 8000:05:41,557 --> 00:05:44,880plumbing problem. It's a good way to think about it, in other 8100:05:44,901 --> 00:05:48,988words as a blockage of blood supply to the heart via its 8200:05:49,048 --> 00:05:54,305coronary artery vessels And so as a result of this blockage 8300:05:54,365 --> 00:05:57,011either partial or complete, let's say complete blockage 8400:05:57,800 --> 00:06:01,387blood cannot get to the muscle of the heart and the heart then 8500:06:01,709 --> 00:06:05,685cannot pump in, the heart goes into a failure or just stops 8600:06:06,468 --> 00:06:12,350many times Frequently. It's not uncommon that these symptoms of 8700:06:12,370 --> 00:06:17,124the heart attack could be gradual, maybe discomfort, which8800:06:17,124 --> 00:06:20,355then may increase in time depending on level of exertions 8900:06:21,158 --> 00:06:25,360and depending on the patient's prior medical condition. But the9000:06:25,360 --> 00:06:29,920presentations were pretty specific. But there was one 9100:06:29,982 --> 00:06:33,860problem with the presentation for the heart attack And the 9200:06:33,879 --> 00:06:39,009Fremenhem study, which was, as Isaid, was the main source of 9300:06:39,089 --> 00:06:43,505information about this is that the Fremenhem study did not 9400:06:43,605 --> 00:06:47,348include women. The Fremenhem study again, remember this was 9500:06:47,831 --> 00:06:52,701probably in the 50s and the 60s,if not before the 70s, and back9600:06:52,701 --> 00:06:57,651in those days a lot of the large studies did not include 9700:06:57,672 --> 00:07:03,264women At least this one did not And the heart attack was 9800:07:03,365 --> 00:07:09,384primarily considered, primarily a male disease And, as a result,9900:07:09,384 --> 00:07:12,451treatment and therapy and education was based on that. 10000:07:13,160 --> 00:07:17,853What was discovered subsequentlywas that when women have a 10100:07:17,894 --> 00:07:22,184heart attack, that they don't proceed through the classic 10200:07:22,223 --> 00:07:28,461Fremenhem study process, that many times women may not have 10300:07:28,480 --> 00:07:31,387the crushing sub-sternal chest pain that radiates to the left 10400:07:31,569 --> 00:07:38,601arm, that indeed they may come in with nausea, they may come in10500:07:38,601 --> 00:07:43,821with a bad case of indigestion or extreme fatigue, they may 10600:07:43,841 --> 00:07:46,928have some chest pain, but it might be in the lower chest of 10700:07:46,949 --> 00:07:51,326the upper abdomen And, as a result, there's a whole area of 10800:07:51,406 --> 00:07:55,699quality healthcare that has occurred in the last 50 years. 10900:07:56,180 --> 00:08:02,572To improve the quality of treatment for heart disease in 11000:08:02,692 --> 00:08:07,468women Because it was finally realized that the presentation 11100:08:07,951 --> 00:08:12,163and the approach and the effect of heart disease in women was 11200:08:12,322 --> 00:08:17,730different from that of men, and to provide quality care for 11300:08:17,750 --> 00:08:20,600women who have heart disease, particularly progressing to a 11400:08:20,641 --> 00:08:23,747heart attack, you have to understand what the methodology 11500:08:23,947 --> 00:08:28,139is in women and the presentation, the signs and symptoms. So a 11600:08:28,199 --> 00:08:32,951very, very important change or growth in healthcare that women 11700:08:33,010 --> 00:08:37,506are not like men 100% in the waythey present with a heart 11800:08:37,547 --> 00:08:45,120attack. Not too long ago. That was a situation in one of our 11900:08:45,200 --> 00:08:48,913national pastimes, football, where a particular football 12000:08:48,932 --> 00:08:53,847player was playing in a game very aggressively, was hit and 12100:08:53,888 --> 00:08:56,897immediately fell to the ground and his heart stomped, 12200:08:57,950 --> 00:09:01,197immediately, fell to the ground and they noticed he did not have12300:09:01,197 --> 00:09:06,897a pulse And so it concluded. The conclusion was immediately 12400:09:06,937 --> 00:09:11,559that he had a cardiac arrest. Sowe just talked earlier about 12500:09:11,600 --> 00:09:13,910the heart attack. That's a plumbing problem. Remember we 12600:09:13,951 --> 00:09:18,182talked about how the arteries and vessels to the muscle were 12700:09:20,168 --> 00:09:24,457narrowed or blocked completely and the heart then stops beating12800:09:24,457 --> 00:09:30,557. But in this situation the heart stops immediately after 12900:09:30,639 --> 00:09:35,355this traumatic hit. And so what we're talking about secondly 13000:09:35,417 --> 00:09:40,154here is a cardiac arrest, and a cardiac arrest is not a plumbing13100:09:40,154 --> 00:09:44,195problem like heart attack. Cardiac arrest is an electrical 13200:09:44,254 --> 00:09:48,676problem. Electrical problem Because another part of the 13300:09:48,736 --> 00:09:51,109anatomy of the heart, in addition to the muscle and the 13400:09:51,149 --> 00:09:56,000blood supply, it is an electrical unit that there's an 13500:09:56,100 --> 00:10:01,611electrical charge that starts inthis sinoatrial node, the SA 13600:10:01,672 --> 00:10:05,019node, that spreads its electrocurrent throughout the 13700:10:05,058 --> 00:10:10,876heart, that allows the muscle tocontract and expand as needed 13800:10:10,956 --> 00:10:15,051and depending on the supply needed by the body. So the heart13900:10:15,051 --> 00:10:18,399is a very complex organ and it's more than just the muscle, 14000:10:18,779 --> 00:10:22,535but it's also an electrical unit. So if you do something, if you14100:10:22,535 --> 00:10:26,610interrupt that electrical flow,that heart will immediately 14200:10:26,750 --> 00:10:30,558stop or certainly begin to function in a way that is not 14300:10:30,620 --> 00:10:34,600productive. Sometimes it may go into what we call ventricular 14400:10:34,620 --> 00:10:39,033fibrillation, where the big ventricles of the heart do not 14500:10:39,715 --> 00:10:43,750pump adequately, but just sort of quiver, if you will, and with14600:10:43,750 --> 00:10:46,525that quivering blood does not get around to other parts of the14700:10:46,525 --> 00:10:51,892body and the patient is in extreme condition And if 14800:10:52,011 --> 00:10:55,364intervention does not occur, that patient could die and 14900:10:55,443 --> 00:10:59,611certainly could very well becomebrain dead. What we know is 15000:10:59,692 --> 00:11:03,600that obviously the most sensitive organ in the body to 15100:11:03,639 --> 00:11:07,572blood loss, among others, is thebrain, and usually you have 15200:11:07,611 --> 00:11:11,159about three to four minutes to get that going again, if indeed 15300:11:11,220 --> 00:11:14,657that's what has occurred, and this was what happened with Mr 15400:11:14,697 --> 00:11:20,731Hemlin. So let's summarize what we just said here Heart attack 15500:11:21,253 --> 00:11:25,716is the plumbing problem. The arteries are clogged up so that 15600:11:25,796 --> 00:11:29,191blood that normally would go to the heart muscle cannot 15700:11:29,410 --> 00:11:33,291adequately get there in sufficient quantities. Pneumatic15800:11:33,291 --> 00:11:38,304arrest is an electrical problem. After a traumatic blow to the 15900:11:38,365 --> 00:11:43,073heart, for whatever reason, the electrical system is disrupted 16000:11:44,000 --> 00:11:47,828And because of that disruption the current does not go to the 16100:11:47,889 --> 00:11:51,924muscle the heart muscle properlyand the muscle is the heart is 16200:11:51,945 --> 00:11:57,798then rendered inadequate in terms of fulfilling its role in 16300:11:58,200 --> 00:12:03,711getting blood supply to the restof the body. So what can you do16400:12:03,711 --> 00:12:06,923? Let's say you're in an area, let's say you're walking through16500:12:06,923 --> 00:12:10,972an airport and you have time tocatch your plane, and in the 16600:12:11,879 --> 00:12:14,969area is a little crowded and a lot of people moving back and 16700:12:15,009 --> 00:12:20,451forth, and all of a sudden there's a person walking who 16800:12:20,490 --> 00:12:25,945begins to slow, let's say an elderly person, and they're sort16900:12:25,945 --> 00:12:28,909of grabbing their chest and they immediately fall in the 17000:12:28,929 --> 00:12:36,230middle of the airport area. You then go up to them and you say 17100:12:36,291 --> 00:12:38,460something, along with other people, to them, and they're not17200:12:38,460 --> 00:12:43,533responsive. And you touch them,you feel for a pulse and you do17300:12:43,533 --> 00:12:47,443not feel a pulse. This is wherecardiopulmonary resuscitation 17400:12:47,504 --> 00:12:53,419comes in and basically many of you already know this, but I'm 17500:12:53,440 --> 00:12:56,270going to go over it anyway. Thisis where you start 17600:12:56,311 --> 00:13:00,484cardiopulmonary resuscitation. You've seen it on television and17700:13:00,484 --> 00:13:07,298what you do is that you first would have someone call 911, if 17800:13:07,337 --> 00:13:11,947you're not by yourself and you would then lean over the person,17900:13:11,947 --> 00:13:18,181be 90 degrees to them and put your the palm of your hand in 18000:13:18,221 --> 00:13:23,673the middle of their chest bone we call it the sternum about 18100:13:23,754 --> 00:13:30,168halfway down and middle of the chest, at 90 degrees, and you do18200:13:30,168 --> 00:13:34,32030 compressions and two breaths. Now, some people just do the 18300:13:34,440 --> 00:13:36,769compression, some people are uncomfortable doing the breaths,18400:13:36,769 --> 00:13:41,224that's okay, but it's importantto do the compressions after 18500:13:41,264 --> 00:13:45,697you've called. I had someone to call 911, if you're able to. So 18600:13:45,758 --> 00:13:49,565cardiopulmonary resuscitation involves 30 compressions, two 18700:13:49,625 --> 00:13:56,562breaths, 30 to two, and it's very important to do that. If it18800:13:56,562 --> 00:14:00,615is a child, then you would do Iwas, depending on the age of 18900:14:00,635 --> 00:14:03,966the child, but a very small child you could do 15 19000:14:04,005 --> 00:14:09,020compressions to one breath. The most important thing is the call19100:14:09,020 --> 00:14:14,850911. If, on the other hand, in addition to all of that, you are19200:14:14,850 --> 00:14:20,009in an area that has what's called a detribulator and more 19300:14:20,029 --> 00:14:22,700and more detribulators being placed in public areas now, 19400:14:22,840 --> 00:14:25,249particularly in airports and other places stores, large 19500:14:25,308 --> 00:14:29,759stores, malls Usually these are things on the wall with bright 19600:14:29,879 --> 00:14:33,600colors and they'll say AED and that stands for automated 19700:14:33,720 --> 00:14:36,988external detribulator. If you see that, you can open that up 19800:14:37,730 --> 00:14:40,322and basically that's the way where you can actually shock the19900:14:40,322 --> 00:14:45,378heart to start electrical activity. So let me go over this20000:14:45,378 --> 00:14:51,772again. You're in the airport, you observe a person fall and 20100:14:51,812 --> 00:14:56,261become unconscious and appears that they may very well have had20200:14:56,261 --> 00:15:00,897a cardiac arrest. After you evaluate them, you call 911. If 20300:15:00,937 --> 00:15:03,648there's someone with you they can help you. If there's no one 20400:15:03,687 --> 00:15:06,941with you and you believe this person is unresponsive, you 20500:15:06,961 --> 00:15:09,628cannot fill a pulse, then it's appropriate to start 20600:15:09,668 --> 00:15:15,587cardiopulmonary resuscitation 30compressions to two breaths. So20700:15:15,587 --> 00:15:18,533let's summarize what we just said. Heart disease is the most 20800:15:18,620 --> 00:15:22,092common cause of death in the United States. Two of the most 20900:15:22,133 --> 00:15:26,043common types of heart disease they call death are heart 21000:15:26,082 --> 00:15:30,932attacks and cardiac arrests. Mendiffer from women with heart 21100:15:30,991 --> 00:15:35,626attacks in that women don't havethe classic crutch and 21200:15:35,667 --> 00:15:38,980substernal chest pain with pain that radiates down the left arm.21300:15:38,980 --> 00:15:42,613Women may present with any number of symptoms. So one has 21400:15:42,653 --> 00:15:46,981to have a high index of suspicion as to whether a woman 21500:15:47,062 --> 00:15:50,945is having a heart attack when you see them or evaluate them. 21600:15:51,706 --> 00:15:54,533Cardiac arrest, on the other hand, is completely different. 21700:15:55,105 --> 00:15:58,133This will be something that's very dramatic, that will happen 21800:15:58,173 --> 00:16:01,691immediately, and the person willgo from being conscious to 21900:16:01,730 --> 00:16:06,831being unconscious many times. There you have Menistor Act and 22000:16:06,892 --> 00:16:10,370if you're comfortable with CPR cardiopulmonary resuscitation, 22100:16:10,972 --> 00:16:15,488cold 911, have someone call 911,do cardiopulmonary 22200:16:15,528 --> 00:16:20,047resuscitation 30 compressions totwo breaths and continue that 22300:16:20,508 --> 00:16:25,985until you get assistance or until the patient responds. I 22400:16:26,025 --> 00:16:30,316would recommend, if you do not have formal CPR training, that 22500:16:30,355 --> 00:16:35,169you get the CPR training. Usually It's given in schools, 22600:16:35,350 --> 00:16:40,773many times in churches, the firedepartment or adult education 22700:16:40,913 --> 00:16:44,374areas. It's just something good to have just training this good 22800:16:44,413 --> 00:16:49,947to have because you never know My basic principles And remember22900:16:49,947 --> 00:16:52,793what I said. When I get to my basic principles, i'm just about23000:16:52,793 --> 00:16:57,546done. My first basic principle is that God is in charge. I am a23100:16:57,546 --> 00:17:01,827physician, but I am a physicianof faith, and God has been very23200:17:01,827 --> 00:17:05,465important to me in my journey throughout life in terms of 23300:17:05,527 --> 00:17:09,194dealing with different issues and trying to make a difference 23400:17:09,276 --> 00:17:12,553in the world. My second principle is I have no bad days.23500:17:12,553 --> 00:17:16,654I decided I learned a number ofyears ago that whether my day 23600:17:16,674 --> 00:17:21,088was good or bad was completely up to me. So, with that being 23700:17:21,108 --> 00:17:24,207the case, i decided that I had had enough bad days and I did 23800:17:24,227 --> 00:17:27,791not want any more. So I don't have. I have good days and I 23900:17:27,832 --> 00:17:31,186have great days, but I don't have bad days. Number three 24000:17:31,367 --> 00:17:34,625don't sweat the small stuff, andmost stuff is small. I have 24100:17:34,705 --> 00:17:38,034also learned that usually if something happens in my 24200:17:38,054 --> 00:17:44,836throughout my day that appears to be important or traumatic or 24300:17:44,895 --> 00:17:48,432stressful, that most of times it's never as stressful as I 24400:17:48,472 --> 00:17:53,047think it is or as important as Ithink it might be, and usually 24500:17:53,146 --> 00:17:55,814I can take a more deliberate approach and resolve whatever 24600:17:55,854 --> 00:18:00,825that issue is. Number four forgiveness is therapy. If 24700:18:00,945 --> 00:18:06,607someone does something in my perception that I consider to be24800:18:06,607 --> 00:18:12,729negative or disruptive or inappropriate, i have learned to24900:18:12,729 --> 00:18:19,576forgive them. And not only doesforgiveness remove that as an 25000:18:19,655 --> 00:18:24,345issue for me, I have found that it is absolutely therapeutic And25100:18:24,345 --> 00:18:26,952I certainly recommend that to you in the appropriate 25200:18:26,972 --> 00:18:31,305circumstances. And finally, everything is a relationship And25300:18:31,305 --> 00:18:35,374relationships are based on mutual respect, mutual trust and25400:18:35,374 --> 00:18:39,029good communication, and it doesnot matter what type of 25500:18:39,069 --> 00:18:43,111relationship it is A husband, wife, work relationship, parent,25600:18:43,111 --> 00:18:49,330child, colleague, colleague If you're able to provide or create25700:18:49,330 --> 00:18:53,625mutual respect, mutual trust and good communication, then you25800:18:53,625 --> 00:18:56,473will have a very, a number of very good relationships 25900:18:56,513 --> 00:19:00,333throughout life and will be happy and less stressful as a 26000:19:00,393 --> 00:19:05,994result. I want to go over a veryimportant area that has to do 26100:19:06,115 --> 00:19:09,348with cardiac disease, and this may seem a little strange to you26200:19:09,348 --> 00:19:13,586, but remember, the body is one unit all together, and all the 26300:19:13,645 --> 00:19:17,047different parts of the body worktogether, and so I want to 26400:19:17,166 --> 00:19:22,465close with a brief discussion about stress management. Stress 26500:19:22,547 --> 00:19:25,095is one of those things that occurs to us every single day, 26600:19:25,184 --> 00:19:29,049but we don't pay much attention to it, but yet it's an important26700:19:29,049 --> 00:19:32,412part of our lives, and not onlyis it an important part of our 26800:19:32,471 --> 00:19:35,750mental life, it's also an important part of our cardiac 26900:19:35,830 --> 00:19:40,391life. Okay, so one of the thingsI want to have you to keep in 27000:19:40,451 --> 00:19:47,726mind that throughout your daily life, it is okay to say no. I 27100:19:47,766 --> 00:19:51,227have noticed in my practice overthe last 15 years that many 27200:19:51,287 --> 00:19:55,115patients who came to see me and who were stressed were 27300:19:55,214 --> 00:20:01,434frequently individuals who had difficulty saying no. No means 27400:20:01,555 --> 00:20:08,172no. You can say it with a smile,you can say it with a hug, but 27500:20:08,231 --> 00:20:13,011it still means no. What it does is it gives the individual, it 27600:20:13,031 --> 00:20:17,789gives you the opportunity to have some control over your life27700:20:17,789 --> 00:20:22,618, instead of always allowing others to dictate what you do 27800:20:22,765 --> 00:20:26,489and when you do it, and you would be amazed at how having 27900:20:26,509 --> 00:20:31,069just a small amount of control will be beneficial. So learn how28000:20:31,069 --> 00:20:36,108to say no. Remember that the mind is divided into the ego and28100:20:36,108 --> 00:20:40,686the superego. The ego is basically responsible for 28200:20:40,767 --> 00:20:44,582wanting certain things for the individual, and the ego really 28300:20:44,642 --> 00:20:48,746doesn't care about anybody else.The ego is the rational part of28400:20:48,746 --> 00:20:51,865the mind. It's the part of the mind that tells you whether 28500:20:51,884 --> 00:20:55,500something that you want to do isreasonable or not, and the 28600:20:55,560 --> 00:20:59,622superego is the right and wrong part of the mind. I would 28700:20:59,662 --> 00:21:02,955encourage you to remember those three different parts of your 28800:21:02,996 --> 00:21:07,542mind and to utilize them at all times. One of the things that we28900:21:07,542 --> 00:21:13,079know is that what we believe affects how we think, and how we29000:21:13,079 --> 00:21:18,271think affects how we feel, and how we feel affects how we act. 29100:21:19,019 --> 00:21:23,653So if you find yourself constantly stressed, it may be 29200:21:23,773 --> 00:21:27,663something that stems back from your belief system, many of 29300:21:27,702 --> 00:21:30,753those beliefs that may have started in childhood or early 29400:21:30,835 --> 00:21:34,968adulthood. I would suggest to you to go back and evaluate a 29500:21:35,048 --> 00:21:38,759circumstance or an encounter, ifyou will, that may have been 29600:21:38,820 --> 00:21:42,969negative or you perceived as negative, and see if it's based 29700:21:43,089 --> 00:21:48,020on some old belief that you've had for many years. Many times 29800:21:48,101 --> 00:21:51,529when you do that, you will find out that that belief is no 29900:21:51,589 --> 00:21:56,500longer tenable and you can change it or get rid of it. And 30000:21:56,520 --> 00:22:01,192finally, i want to end up with the word think. Before you speak30100:22:01,192 --> 00:22:05,101And certainly our parents wouldtell us that, but think about 30200:22:05,121 --> 00:22:11,567it in terms of a mnemonic, to some extent The teeth. Before 30300:22:11,606 --> 00:22:15,018you speak, make sure that what you think is true about 30400:22:15,117 --> 00:22:20,747something or some circumstance. Before you speak, make sure that30500:22:20,747 --> 00:22:25,163what you think is helpful. Before you speak, make sure that30600:22:25,163 --> 00:22:30,907what you think is inspiring Andmake sure that what you are 30700:22:30,928 --> 00:22:36,465going to say is necessary. And finally, before you speak, make 30800:22:36,526 --> 00:22:40,761sure that what you're going to say is kind. If you're able to 30900:22:40,863 --> 00:22:45,296do all those things, you're ableto release your own personal 31000:22:45,336 --> 00:22:50,993power, be less stressed and be less inclined to having serious 31100:22:51,435 --> 00:22:57,204cardiac pathology. Final commentThank you so much for coming 31200:22:57,265 --> 00:23:00,781and being a part of this podcast. Please share it with your 31300:23:00,842 --> 00:23:05,751friends and remember be the change you want to see in the 31400:23:05,791 --> 00:23:07,845world. Have a wonderful day. 31500:23:08,700 --> 00:23:10,423Speaker 1: Thanks for listening to the Healthy, wealthy and Wise31600:23:10,423 --> 00:23:15,489Podcast with Dr William Choctaw, mdjd. We hope you enjoyed this31700:23:15,489 --> 00:23:18,584episode on mental health matters And if you found this 31800:23:18,624 --> 00:23:22,940episode helpful, you can supportand subscribe to the podcast on31900:23:22,940 --> 00:23:27,259your favorite podcast platform with the keywords Dr William 32000:23:27,278 --> 00:23:31,104Choctaw And you've got it. This will help ensure that you don't 32100:23:31,144 --> 00:23:34,803miss any future episodes. And then take the next step of 32200:23:34,983 --> 00:23:38,010action and share it with your family, friends and all your 32300:23:38,030 --> 00:23:42,000coworkers. They'll be glad you did So. Until the next time, 32400:23:42,580 --> 00:23:45,383live your best possible life thebest possible way.