Hillary Pumpkin

Happy Halloween everyone! So what exactly is the Hillary equivalent of "Trumpkin"? I heard Howlery, but that seems more like a werewolf costume... and Clint-kin or Clinton-kin doesn't sound very nice. Pumpkin-ary? Pump-tin? Hillary-kin? I think I like that... Hillary-kin.

Not to be outdone, and not wanting my pumpkin carving to seem like I'm making any sort of political statement, I thought I'd follow-up my Trumpkin carving with a Hillary-kin. Just some good 'ol Halloween fun.

For the record, this pumpkin took me much longer than the Trumpkin. I think it is was really hard to find a photo that I thought I could translate into a pumpkin. I went through around 11 photos and kept asking friends which ones looked distinctly "Hillary". In the end I decided her smile and cheeks were her more attributable characteristics and thought the following picture (by photographer Gage Skidmore) captured her nicely.

Click Here for Original

After deciding on the photo, I created a black and white version and started carving. About halfway through, I cursed myself for deciding to pick one with teeth as I had to carefully carve out her gumline. On the plus side, if being a doctor doesn't work out, I think I have potential as a dental hygienist. And then the hair... that took a while too. I actually stopped fussing with the hair because midnight struck and I could feel myself turning into a pumpkin (pun intended... I crack myself up).

I've learned some things about both candidates from doing this exercise. For instance, I learned they both have double eyelids, and those are annoying to carve. Although it might not influence my decision this election cycle, overall this has been a fun project. So regardless of your political views, hope you enjoy.

Below is a picture of the pumpkin itself without the lighting.

My Trumpkin

After a four year hiatus from carving (I blame residency), I got back into pumpkin carving this year! 

This year, I jumped on the trend and carved a Trumpkin!

I took the original picture from the web: 

Source:  http://media3.s-nbcnews.com/j/newscms/2015_33/1165401/150810-donald-trump-debate-743a_ded2a0af932f2c2332757273ea911da2.nbcnews-fp-1200-800.jpg

Then created a black and white version to trace onto a pumpkin. All in all, it took me around 6 hours to do.

Previously I've memorialized recently passed celebrities that have inspired me, like my last pumpkin of Steve Jobs. 

This year, however, the election has just been so pervasive in our live that I just decided to adhere to that theme. Although I do obviously have my own political inclinations, this is really just to have some fun with an otherwise not fun election cycle. I actually tried to carve a Hillary pumpkin too, but it didn't end up looking like Hillary at all. I might try again next weekend. 

In case you're curious, this is what the pumpkin looks without the light.

You can only do what you're going to do

I'm continuing on my series of posts on advice I share with patients who are interested in losing weight or starting a healthy lifestyle. Today, I'm going to share my most used motto that I tell all my patients interested in lifestyle modification. They've all heard it at least once, but probably more, because it is represents my most firmly held core belief in approaching behavior change: You can only do what you're going to do.

I've heard colleagues complain about how patients never do what they tell them to do, particularly for diet and exercise. In my head, I think, "I feel like a lot of patients do what I tell them to do..." and then I realize, "Oh yeah, that's because I never tell them to do anything." That makes it a pretty easy goal to reach! However, as lazy as that sounds, this is more than me just lowering my standards of success.

When a patient asks me what they should do to be healthier, I won't answer. Instead I ask, "You tell me, what can you do to be healthier?" I want people to tell me what they think they can realistically do to be healthier. Maybe I'm just cynical, but I feel like if I tell someone what to do, they're not going to do it anyways, so I don't see the point. Sure, I can spout out the American Heart Association's recommendation of 150 minutes a week, or 30 minutes a day for 5 days a week, but if only it were that easy, all of us would be doing what we were supposed to be doing. Being un-athletic myself, when I first started exercising, hearing something like 150 minutes a week would have floored me. Someone might as well have told me to train for the Olympics to get a gold medal in men's gymnastics. In my mind's eye, both would have been equally impossible and unobtainable, so why bother trying?

Instead of giving recommendations that might seem unrealistic, I try to get people to tell me what they'll actually do. And that's when I say it: You can only do what you're going to do, so tell me, what is it that you're going to do? I never care how small the goal is, someone could tell me they'll eat 1 more raw baby carrot a week for 2 weeks. Fine. I'll take it.

It isn't about having good habits, it's about learning you're capable of making changes to develop better habits. It's about shifting the internal monologue from I can't, to I can, one baby step (or baby carrot) at a time. One might think that my general reluctance to educate patients on diet and exercise is absurd, but my other philosophy is: Patients aren't stupid. For the most part, people know some foods are healthier than others, or that exercise is good for them. They don't need me to tell them that. Granted, there are exceptions, including those that have been led astray by food marketing, or have already made obvious changes and are running out of ideas, or have a question if a proposed change is actually a healthy decision. However, the majority of average people, like you and me, probably have some pretty obvious things that we can think of to change for the better.

So my advice from today's post: don't rely on someone else to tell you what to do, because only you

Do, or do not. There is no try. - Yoda

know what you can and can't do. These are your habits and it's for your health, so take control and own it. Pick a healthy habit you're going to do for two weeks. Not "try" to do, but actually do. When I have a patient say they'll "try" to do something, I work with them to think of smaller goals until they stop saying, "I'll try" and start saying, "I will". I've named this very official medical technique, the Yoda maneuver. Then, once you've achieved one goal, pick something else you're going to do for a few weeks. Just keep focusing on what you're going to do. Don't worry about what you "should" be doing, because what's the point of knowing what you "should" do if you're not going to do it? In the end, you can only do what you're going to do.

Don't lose weight to be healthy

For the next few posts, I just want to talk about pieces of advice that I give patients who tell me they want to lose weight. This isn't so much for other clinicians who have their own styles (that may or may not work better for you than mine would anyways), but more so for people that have thought about losing weight, and just want to hear the advice I give.

The first piece of advice is not to lose weight to be healthy. Instead, find a more concrete aspiration. Let me explain what I mean. When I ask patients why they want to lose weight, more often than not, I get told some variation of, "I want to be healthy." It seems like the right answer that a doctor should be happy with, I mean that's what we want for all our patients right? The problem is, I'm not really sure what it means "to be healthy", and I don't think most people do either. It is just something that sounds good.

Let me explain before my medical training gets called into question because someone thinks that, at baseline, a doctor should know what "being healthy" means. For me, the concept of "being healthy" is too conceptual and abstract. It can mean different things to different people. For instance, imagine you were walking down the street and happen to bump into someone you haven't seen in a while, who says, "Hey, you're looking really healthy since the last time I saw you!" I don't know about you, but I'd be like, "Wait, I think they just called me fat..."

The term healthy is just so vague. It's not like we can wake up and go, "I'm more healthy than I was yesterday". There's no real way to know when you've progressed. It is a very abstract descriptor, like being rich. When would you know if you were rich enough, and similarly, when would you know if you were healthy enough? So instead, I try to look for more detailed answers to define health, specifically, what are the things a patient would like to realistically do that he/she currently can't do. What are they trying to get out of this improved health? Sometimes it is as simple as getting off of a medication, but sometimes it is more emotional, like being able to do some activity with their children. I believe you can't take away something someone enjoys (and unfortunately a lot of unhealthy habits are really enjoyable), without finding something else that is worth giving it up for.

So that's my first piece of advice, don't try to lose weight to be healthy, instead try to soul search to find a more detailed answer as to what it means to you to be "healthy" and why you want to be healthy. (Plus I don't like how weight is a proxy for health, but that's another topic for another time). What is it you're hoping to achieve? Hopefully the desire to achieve whatever it is you are driving towards will override the desire to have a donut, or ice cream, or fried chicken (all the above are my vices, everyone has their own). Dean Ornish, Clinical Professor at UCSF and preventive medicine guru, put it nicely in his Ted Talk when he said, "Many of you have kids, and you know that’s a big change in your lifestyle, and so people are not afraid to make big changes in lifestyle if they’re worth it[...] For many people, those are choices worth making -- not to live longer, but to live better." So would make you feel like you were living better? What are the things you love that you want to be able to do more of or better? Everyone has to answer that for themselves, but I don't think it is even worth talking about diet and exercise, as mentioned in a previous post, until we've figured out why we're going to undertake a healthy lifestyle journey in the first place.

In case you're curious in what ways I'm living better and how it motivates me, I'll say that what brings me great joy is to be able to do fun activities that I never thought possible. It makes me really proud to do something new, like finishing my first sprint length triathlon earlier this month. I always put people that could do things like that on a pedestal and felt like I'd never be good enough enough to do it, and so it feels kinda awesome to know that I am good enough! It is a huge self confidence booster. The other thing is I love to travel, explore, and have fun adventures, so I love being in shape enough to do unique activities when traveling and/or exploring. For instance, this past weekend I biked 32 miles around Los Angeles to see the sights, and am preparing for a trip to Scandinavia this July to bike from Norway to Finland. I'd never be able to do these types of unique adventures, or experience a country in this way, without being in shape enough to do it. This makes me happy.

Map of Los Angeles bike ride for "City of Angeles Fun Ride"

Biking in the Wildflower Triathlon May 1, 2016