Monday, October 14, 2013

THAT was an awkward doctor's visit: Being on the other side

I went in to see my primary care physician last week... and learned I had gained around 10 lbs in the last few months. The conversation went like this:
Doctor: "So... you gained 10 lbs since I last saw you... you're still ok, but is this becoming a trend?"
Me: "Oh...I wore shoes on the scale this time."
Doctor: "Shoes don't weigh 10 lbs..."
Me: "I...I...also had my wallet and keys..."
Doctor: "We're still looking at at least 5 lbs..."
Me: "It's all muscle!!!"
Doctor: "Oh have you been weight training?"
Me: "Yeah! See?" <flexing so he could see my new muscles>
Doctor: "It's not all muscle... what have you been eating? Are you still exercising?" 

AAAHHHHHH!!! How did this happen? After all the time I spend counseling patients on diet and exercise... it was surreal to be on the other side of it. I felt like a kid being scolded, and I came up with one excuse after another. I wonder if that's how all patients feel when they sit on the exam table: this feeling of being in trouble and not knowing what to do but minimize the problem with excuses. I wonder if I make my patients feel like that. Moving forward, I'd like to be more aware of trying to make lifestyle change discussions more inspirational instead of just pointing out problems. I want my patients to leave the room going, "I'm going to do it" instead of thinking, "I wasn't doing it right..." I'm just not entirely sure how to accomplish this yet. The doctor-patient dynamic inherently makes these discussions so difficult. It is a power dynamic similar to getting sent to the principal's office, and even my first reaction was to go on the defensive. So how do you bring out the pal in princiPAL (saw that on a sign once as a way to remember the different between principle and principal... stuck with me all these years), for the doctor-patient relationship? 

On another note... I'm apparently a non-compliant patient too... At my last visit, my doctor discovered I had a heart murmur and ordered for me to get an ECHO just to see what it was. I wasn't overly concerned about it given that I have been able to run and do Crossfit without feeling light headed or anything... and completely forgot about it. "So did you get the ECHO done?" "What ECHO?" "Last time, we heard a murmur and I ordered an ECHO" "Oh you did? I didn't know that...so...yeah...no.". 

I hope my patients are better patients than I.

Friday, August 23, 2013

Tips to cook with limited time

Hey everyone! Five consecutive weeks of nights down, one more to go. I'm still alive, still kicking, and still cooking. I've gotten some comments about how amazed people are that I'm cooking while working night shifts, and how people feel like they don't have enough time to do it. Not true at all. You can make simple, and delicious meals in barely any time at all. I literally shop and cook for one hour a week. That, along with then just picking out salads or veggies at the hospital cafeteria as I mentioned in my last post, is enough to still have healthy foods around all week. Here's two things that have made cooking super easy:

1) Glass tupperware - What a genius invention! I literally cook, refrigerate, and transport all in the
Chicken in glass tupperware
same container. I cook two servings per container, and then take the entire thing to work, eat one serving that day, and leave the leftover in the fridge in the call room for the next day. Afterward, I just bring the entire thing home and toss it in the dishwasher, it can't get easier. I remember how long it used to take when I cooked in a group to first do the cooking, then have to wait for things to cool before transferring to a container for people to take it home. I just cut out all the time.

Various spices from Penzeys
2) Pre-made spice blends - There's this store around the corner from me called Penzeys spices that sells tons of spice blends that are delicious, but let's be honest, you can buy spice blends from any super market spice aisle, and if you're being Paleo, the ones at Whole Foods are paleo compliant. Just try some random spice, coat your meat/veggies in it, and you're done. If you use multiple spices, then you can have several flavors going the same week. Especially since I'm cooking 2 servings per container, and 3 containers, I use 3 different spices each week.

I cook a week's worth of meals while doing laundry. Literally, I'll go out and buy the groceries while my clothes are in the washer, then come back, put my clothes in the drier, and then cook the food while the clothes are drying. All I do is coat the meat/veggies in spice blend and toss in the oven (if chicken breasts around 25 minutes at 425F). The food is ready and placed on my counter for cooling before my clothes are finished drying. Then after I get my laundry, I'll cover the tupperware and put the food in the fridge. If the containers are still warm, I might put pot holder under so it doesn't hurt my shelf, but other than that, it is done until I take it to work. So if you have time to do laundry, (which I hope you do, because otherwise you're stinky, and according to Kristen Chenoweth who is wise in many things... nobody likes a stinky witch. I'm sure the same applies for doctors.) then you have time to cook.

Do I supplement with eating out? Why yes, yes I do. Do I supplement with some store bought snacks? Yup. I'll write more about those later, but in the meantime, just wanted to show that there's always time to cook. Not having time isn't an actual reason, it is a random excuse because either you don't really want to do it, or don't know how. If the latter, now you know how! :-)

Saturday, August 10, 2013

Don't let an "all or nothing" mindset let your attempts just turn into nothing

In my last post about trying to be healthy in residency, I said that my mantra would be, "You can do anything, you just can't do everything". After my first rotation, I'm realizing that "anything" might be more limited than I originally anticipated. So, unfortunately, my tried and true habit of cooking a week's worth of healthy meals a week at a time has been put on hold, at least for now. Time for a new strategy.

So I'm 3 weeks into a month and a half of being a zombie doctor (no I don't eat patients' brains... I'm referencing being on night shift). During this run of being only up at nights, I discovered two things: 1) I want to go to bed immediately when I get home and sleep for the little time I do have, and 2) On my days off, a combination of having other errands and having a completely zonked out circadian rhythm usually means I'm ready to go grocery shopping at around 1am... which hasn't proved very effective.

Steamed veggies at California Hospital's hot food bar
Salad bar at California Hospital
I also got to thinking... wait a sec... why am I spending so much money on groceries when the hospital pays for my meals at the hospital cafeteria? It is like how Google and other tech companies provides incentives and benefits for their employees working long hours... except the difference is, they actually have good food, or more specifically, more healthy food options. I find hospital cafeterias, just to be lacking in variety, particularly in the department of healthy proteins. So, I learned to compromise. Instead of spending 3-4 hours a week planning a weekly meal, grocery shopping, and cooking, now I spend 1 hour running to the grocery store and buying protein that I then throw random spices onto and bake for 30 minutes while doing other things. I then take 1-2 servings to the hospital every night and combine it with whatever healthy options are available in the cafeteria. Although it's slim pickings, at least so far in every hospital cafeteria I've found at least a bare bones salad bar, and then usually at the hot food station, one of their meals will come with a side of vegetables. So I'll combine my protein with their salad/side of veggies and make my own healthy meal.

Usually I'm a go big or go home type of person... but in this case, I've learned to be in a "I'll use the resources around me to make something work" frame of mind. It saves me time, saves me money, and helps me keep my habits sustainable, because unfortunately, sometimes all or nothing... just turns into nothing.

Saturday, July 27, 2013

You can do anything, you just can't do everything

In the past 2 months, I've been busy transitioning to a new life in Southern California. Sorry for the delay in posts, but it took me a while to get over leaving Stanford as a med student, and adjusting to my new lifestyle as a new Family Medicine resident at UCLA, as well as adjusting to a new city. I think I'm finally hitting my stride though.

In orientation, we were warned about how common it is to gain weight our first year as a resident physician. A combination of stress eating, long and odd work hours that makes exercising difficult, and ironically unhealthy hospital food equates to weight gain for many. After working so hard to lose my 45lbs, I was determined to let this happen to me. My motto to achieve this with such a busy schedule is this: "You can do anything, you just can't do everything." In the context of extremely limited time, I'm just deciding to prioritize my own health and wellbeing, and in doing so, some other things might slide. We'll see how that plays out.

So far so good. I'm trying to just stick to what I know works. I started off my residency on night shift for our family medicine in-patient service the past week, and have one more week to go. Work hours are 6:30pm-7:30am every night, except Monday night where I work until 10am Tuesday morning, and then have Tuesday night off. My routine so far has been to get home and be asleep by 8:30-9am so I can get 7-8 hours of sleep. I then wake up at 4:30pm, and start my night off at my newly found Crossfit Sandbox around the corner for a 5pm workout on Monday, Wednesdays and Fridays. After an hour workout, I jump into the shower at the gym, and then bike to the hospital with enough time to grab a coffee before our 6:30pm sign-out to keep me going through the night. On the days I'm not doing Crossfit, I've been going to the gym to lift weights once a week. I tried to muster up enough motivation to run for an hour on another day, but instead chose to sleep. For diet, I'm also sticking to what I know best: preparing a week's worth of meals at a time. That takes up my Tuesday nights off. I cook enough food to last me through the night, with my "breakfast" at early evening consisting of a salad I get from the cafeteria before it closes. So far it has been fine. What have I given up to do this? Mostly my social life. I did go to dinner with a friend once, but other than that I haven't logged onto facebook, and am not so good about returning social texts/calls. I haven't even turned on my laptop except to write this post in the past week.

Preparing for a week's worth of meals overnight, with meatballs, chicken, veggies, and boiled eggs
In general though, in terms of my fairly recent journey towards a healthy lifestyle, the more things change, the more things stay the same. The only thing I'm really missing is the community I built while in Northern California and my Crossfit Palo Alto community that I used to cook with weekly. Besides being in a new city, it's hard to get people to come cook with you between the hours of 1am-4am. Hopefully the community will come with time, but for now, this works. More to come hopefully next week.

Tuesday, May 14, 2013

My uncensored thoughts on the Paleo Diet

I constantly get questioned from friends about "how did you do it," in reference to my dramatic and sustained weight loss in the last year and half. I attribute a lot of it to changing my diet and adhering to the Paleo diet starting last May 2012 when I participated in my first Whole 30 (adhering strictly to the Paleo diet for 30+1 days for the entirety of May) with Crossfit Palo Alto. Now that I'm two weeks into my second Whole 30 this May, I thought it would be timely to reflect on my thoughts about the Paleo Diet and why I still do it.

Let's start off by addressing the elephant in the room: do I buy into the anthropological philosophy behind the Paleo diet? Absolutely not. If you've heard about the Paleo diet before, you've probably heard that it's a diet where we only eat foods our ancestors ate because that's what our bodies are evolutionarily designed to eat. As such, the Paleo diet does not allow any processed foods (including processed cooking oils), no grains (pre-agriculture), no dairy (pre-domesticated cows), and no sugar. I can buy that... but then, the Paleo diet throws in other rules that I find a bit arbitrary, such as no legumes (including soy or peanuts) or white potatoes. Most critics tend to question the validity of our knowledge of the actual Paleolithic-era diet. In this regard, I tend to agree with the critics. I know nothing about how Paleolithic-era people ate, and frankly, I don't think anyone can legitimately say for sure that they do, so I'm not sure we can accurately reflect a paleolithic-era diet. Then, it begs the question, if I don't believe in the basic idea of the Paleo diet that gives it the namesake, why am I still Paleo?

I've stayed with the Paleo diet, because for me, the point of the Paleo diet isn't to eat what we're evolutionarily adapted to eat, but instead, self-empowerment to make healthy decisions regarding what we eat. That's the real reason I do Paleo. I originally did Whole 30 just because I felt like I had nothing to lose in trying it. I didn't know when I embarked on it last year that it would entirely change my life by changing my relationship with food.

Being strict Paleo for a month changed my eating habits dramatically. In order to adhere to the diet's strict and seemingly odd rules, I had to do several things: 1) Plan my meals so I always had compliant foods available, 2) Prepare my own meals using fresh ingredients, 3) Be extremely conscious of what was in the foods I was purchasing to ensure there were no forbidden ingredients/chemicals, and 4) Exercise self-control. For me, I think these were the benefits of doing a Whole 30. By adhering to these rules for a month, I learned how to be an active participant when choosing what to eat in order to stick to the diet. It was no longer about eating what was around, but eating what I wanted to eat. This meant turning away food and alcohol all the time, not being shy at restaurants to control what I was eating, and checking everything I buy at a supermarket to make sure the ingredients I was using were Paleo compliant. I had gotten so used to these habits, that even after my Whole 30, it became common place for me to try and make smart decisions. At restaurants, I still customize dishes so they are as healthy as possible, such as switching out french fries for a side of vegetables. I still say no to random junk food sitting around and don't eat it just because it is available. I still plan and prepare my meals. The Paleo diet provided me a structure to develop these healthy habits.

You'll see lots of claims on the web about the Paleo diet leading to better sleep, more energy, more normalized insulin levels, less inflammation, and other health claims. I'll get back to you on that. At this point, I don't know if the composition of the Paleo diet is what makes it healthy, and I'm trying to do some reading to make my own informed opinion. However, I do know that I still believe in the Paleo diet because it is what I used to become an active participant in my diet that resulted in jump starting and sustaining my journey towards a healthy lifestyle.