Wellness Rounds

I love when I find new websites that provide great “pizza rule” recipes (recipes that take less time to prepare than it takes to order a pizza).  I just discovered Keep Your Diet Real, a site run by Corrine E. Fischer, MS, RD, LDN.  She’s not only a dietician, but she’s a professional food photographer, so the site is beautiful.  Her recipes are healthy, straight-forward and are great for the busy life of docs, medical students and residents.

Ten Healthy Breakfasts in Ten Minutes or Less

Spring Roll Soup

Wheatberry and Edamame Salad

In keeping with the “pizza rule” (everything we cook needs to take less time than it takes to order a pizza) and the hot weather…. Here’s some new recipes from a site I just discovered www.danispies.com.

Some of you don’t cook or, put more positively, are learning how to cook.   Dani Spies not only has fabulous, healthy and easy recipes but has also posted “Cooking 101” videos like this one called Egg 101.  These are a great resource if you are trying to learn the basics.

Here’s three recipes that meet the “pizza rule” and will make great dinners or on call lunches.

Chunky Greek Salad Topped with Sardines

Clean and Simple Asparagus Pasta

So, so Simple Shrimp Tacos

I was really inspired by a recent post by veggielady4life (a medical student, photographer and foodie!) on taking salads for lunch.  For medical students in basic sciences, this is a great “energy” lunch that lets you stay alert in class.  For students on rotations and residents, a fresh salad is a great lunch and an even better middle of the night meal when you are on call.

The concept couldn’t be easier – put lettuce, spinach, or the greens of your choice in a big container.  Top with protein, cheese, veggies, nuts and/or fruit.  If you don’t care what it looks like, it’s also really easy to dump it all in a big zip-lock bag.  When it’s time to eat, pour the salad dressing in the bag with the salad, shake, and then serve yourself from the bag.

Protein:  Beans from a can, beans you make yourself with a crockpot or pressure cooker (which saves money and avoid excess salt and additives), canned tuna, cooked chicken from the deli, prepackaged meats (look at the labels to make sure you aren’t getting a lot of additives you don’t want), shrimp, etc.

Cheese:  Shredded cheddar, Monterey jack or Mexican cheese (reduced fat or regular), feta, goat cheese, thin slices of parmesan

Veggies:  Any leftover in your refrigerator!  Another good idea for this is to buy what you need for a mirepoix when you do your once a week shopping.  A mirepoix is the basis of  French cooking and is one part onions, one part carrots, and one part celery.  The Cajun trinity is similar but substitutes green bell pepper for the carrots.  If you buy the ingredients for a mirepox (or trinity) and chop it up on the weekend, you can use handfuls in salads, omelets, soups, etc all week.  (You can add other things, too, like mushrooms, red bell pepper, etc – anything that can be eaten raw).  If its a really busy week and you don’t have time to chop up vegetables, you can used canned green beans, corn, beets… whatever vegetables you like.

Nuts and/or fruits: Adding some dried fruits and nuts, sunflower seeds, etc, will add some extra nutrition.  Fresh fruits like blueberries, strawberries, sliced peaches are delicious in salads.  Canned fruits, especially mandarin oranges, are good, too.

Salad dressing. Don’t put the dressing on the salad until you are ready to eat.  (The French say it “cooks” the salad… but the result in any language is soggy salad.) My favorite dressing is a homemade vinaigrette.  Start with vinegar (red wine, white wine, sherry or balsalmic), a clove of diced (not crushed) garlic, a healthy teaspoon of good Dijon style mustard, salt and pepper.  Stir these all together until the salt is dissolved and the mustard is blended with the vinegar.  Add olive oil while you are stirring (or shake it up at the end.)  The classic ratio is 1 part vinegar to 2 parts oil, but you can add less oil to taste.  I usually squeeze a little lemon juice in, too.  There are many different French vinaigrettes, so experiment!

The easiest thing by far is bottled salad dressings.  Be careful about calories (if you are watching your weight).  If you take salads to work regularly, you may want to leave the bottle there (unless the food snatchers raid your refrigerator on a regular basis).

http://allrecipes.com/Recipes/Salad/Green-Salads/Top.aspx

http://hubpages.com/hub/Favorite-Salad-Toppings-Lessons-From-Restaurant-Salad-Bars

http://www.fitsugar.com/Nutritional-Information-Salad-Toppings-7598444

I’ve had several new college graduates ask me what they should do this summer to prepare for medical school.    It’s easy – don’t worry about it!  There is no studying or preparation that will improve how you do.  Seriously, you’ve been accepted and you will do fine.  I know you are anxious, but I can absolutely guarantee you don’t need to study anything to get ready!  That being said, I do have some advice about what to do this summer:

Take a vacation (or two or three…).

• Visit family and friends – take a road trip and connect with people you haven’t seen in a while
• Hang out on a beach, go for some great hikes, read some great novels
• Sleep late, eat well, and just rest

Develop (or strengthen) an exercise habit.

• Use this summer to develop  a daily exercise routine that you can take into your busy medical school life.  Overall, your goal for the summer should be to develop a balanced exercise program (cardio, strength training and flexibility).  If you’ve never done any strength training, hire a trainer and learn about it.  Your goal during medical school should be at least 30 minutes of cardio 4-5 times/week, 2-3 strength training sessions (that cover all the major muscle groups) and stretching everyday.  If you develop a balanced exercise routine this summer, it will be much, much easier to continue this once you start medical school.
• Commit to doing at least 30 minutes of exercise a day this summer.    Running is by far the best cardio exercise for medical students.  Use this summer to become a runner.   http://wellnessrounds.org/why-you-should-run-and-how-to-get-started/

If you don’t know how to cook, learn.

• Learn some basic skills to cook simple things.  If you have good cooks in your family, have them teach you.
• If you don’t have family members who can teach you, find cooking classes  on the internet.  Here’s a site I found that links to cooking classes across the country.  http://www.localcookingclass.com/
• Many high end grocery stores offer simple classes.  For example:  http://www.centralmarket.com/Cooking-School.aspx, http://www.williams-sonoma.com/customer-service/store-events.html, http://www.wholefoodsmarket.com/stores/cookingclasses.php

You may have read the title and thought this might be about work and stress… but, no, it’s not about the pressure cooker at work, it’s about cooking!

If you are trying to save time cooking (which is an essential part of cooking as a student or resident) you should really think about buying a pressure cooker.  This is a foreign cooking appliance to most people, but it is an incredible time saver.  Do not listen to your mother/grandmother/aunt who says they blow up… they don’t!  I use mine more or less weekly to make garbanzo beans.  Buy dry garbanzo beans (which are really cheap), soak them for 4-8 hours  and cook them with a little spice (or not) for 12 minutes on the second ring. (You can skip the soaking and cook for about 15 minutes instead)  They make a great snack (instead of peanuts) right out of the refrigerator.  Another really good use for pressure cookers is to make stock.  When you peel carrots, cut the ends off onions, etc just throw the pieces into a bag in the freezer.  Ditto for leftover bones and bits from fish, chicken, beef (if you want a meat stock).  When the bag is full, put the frozen bits in the pressure cooker with water and cook for 20-25 minutes.  This saves a lot of money and tastes tons better than store bought stock/broth.

Here’s a list of other things you can cook in a pressure cooker

• A whole chicken in 15 minutes
• Beans (from dried) in 5-10 minutes
• Artichokes in 10 minutes
• Potatoes in 5-10 minutes

http://busycooks.about.com/cs/appliances/a/pressurecooker.htm

http://fastcooking.ca/pressure_cookers/recipes_pressure_cooker_index.php

It’s Saturday and I’m on call – and it’s going to be a busy day!  We have about 75 patients on the service, we already have 4 cases done and another 4 posted, and it’s still early (~4pm)   I have a fantastic resident with me today.  We just were chatting about what we are going to do for meals today.  He didn’t have breakfast and has only had a Coke and a “borrowed” bowel of Kix cereal from the recovery room so far.  I had whole wheat toast with some goat cheese before I left my house this morning, and I here’s what I have to eat today:

• Strawberries
• A handful of frozen cooked shrimp with cocktail sauce (they’ll thaw by the time I want to eat them)
• Frozen peas (I put them in the microwave for a minute but, like the shrimp, frozen would be fine because they’ll thaw) + goat cheese, olive oil, vinegar, salt and pepper
• Leftover whole wheat orzo, artichoke hearts, tuna and lemon pasta from last night
• An apple
• Lemon wedges for water

My resident’s Coke is probably more than I used to have as an intern… which is STUPID.   Eating well is important to feel well, perform well and do the right thing for your patients. There is one word that explains the difference between my resident (and what I used to do) and what I do now… planning.   “I’ll just get something from the restaurant across the street later…”, “There will probably be food leftover from the GI conference…” .. “I can always eat a bagel from the lounge..” … NOT.   When you finally have a minute to grab something to eat, you won’t usually have time to go look for the food.  It’s a lot easier if its’ there and ready to eat.

Here’s how to do this right:

1. Buy a good “lunch box” .

I like the hard plastic ones that fit in an outside, insulated carrying case.  It’s a lot easier to clean up if something spills than the usual “lunch box”.

You can use plastic (disposable) containers to carry your meals with you.  I’ve switched to glass containers because some of the data about heating the plastic containers in the microwave started sounding convincing.  It does mean you have to keep track of them and bring them home, but I suspect in the long run (if I don’t lose them) it will be cheaper than the plastic containers.   I particularly like the ones I bought because the seal is so tight that they don’t ever leak  (even for things like soup).

2. PLAN.

The night before call, figure out what you are going to take. Make it good stuff, too!  Call nights are not the “what I know I should eat” nights.  You need to have real food (i.e. not processed) but don’t skimp.  When you get to the “I really deserve those french fries” time of your call (which we all do) you will have really delicious and balanced food  in the refrigerator.

3. Pack your meals for the next day the night before (no matter how late it is or how tired you are).

It’s the only way you’ll actually do this.   None of us when we work this hard have the energy to put together meals for the day at 5am.  This takes a little effort but the payoff is real.  You will absolutely eat better, have more energy, maintain your weight and do a better job.  Don’t forget to throw some fruit in – and to make sure it’s washed so you can just pull it out of the refrigerator for a snack.

Here’s a few more recipes that meet the “pizza rule” (cooking in medical school and residency has to take less time than ordering a pizza).  Here’s the link to my post on cooking for yourself in medical school and residency if you need more info on the “pizza rule”: http://wellnessrounds.org/cooking-for-yourself-in-medical-school-and-residency/

Spinach, Feta and Tomato Quiche

http://www.vegetariantimes.com/recipes/10963?utm_source=Vegetarian&utm_medium=newsletter&utm_campaign=vege175

This is a really easy recipe that uses phyllo dough (which you buy in the frozen food department) as a crust.  Another alternative is to buy frozen pie crust (I prefer whole wheat). You can skip the sesame seeds, but if you choose to use them, make sure you toast them.  Put them in a hot pan and don’t turn away!  Keep shaking the pan and as soon as you smell the sesame dump them out (about a minute or two).  If you don’t have nutmeg, don’t worry about it.

I really try not to mention anything commercial in this blog, but I have to make an exception for spices.  If you like to cook, or are learning how to cook, spices are key.  I order mine online from a spice company www.penzeys.com.   They are fresher than what you buy in the store and about the same price.  More importantly you can buy little (half) jars which saves money and keeps fresher spices in your cabinet.  When you buy spices, whether online or in the store, write the date on the jar.  You should throw them out after 2 years.

21 Superfast Stir-Fries and Sautes

http://www.cookinglight.com/food/quick-healthy/20-20-superfast-stir-fries-sautes-00400000037729/page23.html

This site has 21 different recipes for stir fry dinners that take less than 20 minutes to prepare and all look delicious.  Stir-fries and sautes are always easy, and are going to make up a high percentage of your “pizza rule” dinners.  You’ll need a wok or a saute pan – one of the essentials of a student or resident’s kitchen.  Good cookware is a great thing to ask for as a present (and I just added it to the list of things to buy for someone graduating from medical school!)

If you buy a wok, you have to season it before you use it.  This is not hard, but you’ll look like an amateur if you don’t know about it (and one of my rules is that it’s important to look cool).  Seasoning just means getting a thin layer of oil to incorporate into the surface of the wok.  The key is “burning” it on the first time and then keeping it on by not scrubbing the wok.  After you cook in a wok, clean it with soap and water, but don’t scrub it – if it’s shiny you messed up.

http://thepauperedchef.com/2007/08/when-cheaper-is.html

http://www.asiarecipe.com/woks.html

Most medical students and residents eat poorly.  It’s not really a surprise – the days are packed with work from sun-up to sun-down.  There are no planned meals because there can’t be.  Food is a quick bite when it is available.  It’s feast or famine.  On the far end of the scale, the stereotypical diet of a resident is no breakfast (but usually coffee), a doughnut and coffee grabbed on the run once you get to work, some mid-day meal of fast food, and pizza on call.  Food, particularly fast food, becomes solace.  In the stressful world of residency, this kind of “comfort food” becomes a “reward” for the hard work and tribulations. It’s not rocket science.  This kind of diet doesn’t give you the energy you need to function at your peak.  It is also a diet that is very likely to lead to weight gain.  In your 20s, your body can cope with this suboptimal fuel, but it’s not ideal.  However, what “works” in your 20s won’t work as you get older and could even be responsible for a heart attack, diabetes, or other medical problems in your 40s and 50s.  On a more philosophical level, you would never advise this kind of diet to one of your patients.  None of us want to be hypocrites.

The answer is to cook for yourself.  Not everyone likes to cook, and not every one knows how.   I’m going to make a case that you should learn.  Trust me – if you can learn to take out an appendix, or diagnose a pneumonia, you can learn to cook.   I’m going to assume that you are single for the sake of this description.  But, if you have a significant other, it’s even more important to cook at home.  He or she can participate in helping with the meal preparation, and, by doing this together and for each other, there is added benefit for your relationship.  Having dinner at home with a significant other will become an “anchor” to your day that will become very important to you.  As hard as it is to work around a busy schedule, if you can eat together, and have a real conversation, you will both benefit greatly.

Cooking is a wonderful therapy for the stress of medical school and residency.  If you’ve never learned how to cook, this is a hard time to learn complicated techniques, but it’s not hard to learn simple techniques.  There are several advantages of cooking for yourself that outweigh (on most days) the hassle of spending the time.  The act of cooking for yourself can be a time of “decompressing” from work.  Arranging vegetables, cutting them, smelling the odor of the food appeals to all your senses and is a moment in the day that you can intentionally slow down.  It’s very important that the recipes you choose are simple and quickly prepared.  No one wants to come home to a 2 hour task in the kitchen after a hard day.  Cooking for yourself has other benefits as well.  First, it is tangible evidence that you are taking care of yourself.  This is not a trivial point.  There are days during your training when it seems no one is taking care of you.  Having concrete evidence that you are caring for yourself is an antidote to that feeling.  Secondly, you will eat better.  By cooking from fresh ingredients, you will decrease the amount of pre-packaged and fast food.  Even without medical school, you know that this will result in better nutrition.  Thirdly, you will eat cheaper.  Other than the “free” pizza (ethically debatable, but financially clear), processed food is usually more expensive.  And lastly, you can share.  It isn’t any more work to make 4 or 6 portions of a dish than it is to make 2, and it usually isn’t that much more expensive, either.  If you can convince one of your colleagues that this is a good idea, you can cook for each other on alternate days.   Likewise, you can cook larger amounts and, using freezer ready containers, freeze portions for yourself for the future.  Doesn’t homemade pasta with a side of fresh vegetables really sound better than the greasy middle of the night food that is available in most hospitals?   It’s true that you can’t cook just anything with the kind of schedule you will have in medical school and your residency.  But, there are few key rules that will make it possible for you to do this, enjoy it, and eat well.

Rule 1:  Don’t cook anything that takes more than 30 minutes to prepare.

Let’s be realistic – you are not going to walk into your home at 8 o’clock at night, hungry, and spend an hour preparing something.  But – there are very nutritious dinners that take less than 10 minutes, so getting home late is no excuse.

Rule 2:  Plan ahead.

The first step in preparing dinner for most busy people is to open the refrigerator door and ask “What can I eat tonight?:  If you are anything like I was in residency, the refrigerator had some cheese, some vegetables (often way past their prime), and maybe some leftovers.  Not very appetizing.  There is an easy way to prevent this from happening.  On whatever day you have off and have time to shop, spend 30 minutes making a menu.  Start by making a table for the week with what is happening.

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after rounds
Thur
Fri					On call
Sat

Once you have an outline of your week, fill in the blanks with the meals.  Now, most of us can handle “hamburgers” or “Raisin Bran” as a menu item… but it’s more fun, and healthier to branch out a bit.  So, if you are not used to looking for new things to cook, how do you find recipes?  Cookbooks can be fun, particularly if you are looking for a particular ethnic food or a style (e.g. low-fat) of cooking.  If you like cookbooks, and bookstores, find the used book store nearest you and go to town!  There are also web sites for recipes.  Many of them also have “cooking lessons” on line.  Most cooking shows have a web based recipe site as well.   So, say you start by searching the web and find this recipe. (for this particular recipe, I’m assuming you have no concerns about calories)  It looks easy, and like it would taste good.   So you print it out.

NEW ORLEANS PASTA

ESSENCE OF EMERIL (FOODTV)   SHOW #EE123 – http://www.recipesource.com/main-dishes/pasta/11/rec1100.html

1 tablespoon olive oil

16 ounces chicken breast half, cut into strips (about 1/2 cup)

1/4 cup chopped chorizo sausage

2 tablespoons chopped green onions, plus extra for garnish

1/2 tablespoon chopped garlic

Tabasco and Worcestershire sauce

3/4 cup heavy cream

1/4 cup grated Parmesan cheese

1/4 pound shrimp, peeled and deveined

1/2 pound penne pasta, cooked al dente and tossed in oil to coat

Creole spice, salt and pepper

In a large saute pan heat oil, add chicken and sausage and cook 5 minutes, stirring often. Add green onions, garlic, 2 dashes each Tabasco and Worcestershire sauce or to taste, and cook for 1 minute. Add cream, cheese, shrimp and pasta. Cook, tossing, to heat through. Adjust seasoning to taste with Creole spice, salt and pepper. Serve garnished with green onions.

Yield: 2 servings

Now what?  First, cut and paste the ingredient list to a shopping list.  If you are compulsive, you can organize it into meat, dairy, produce, etc (it makes shopping easier, but it’s not essential).  You’ll need to add a vegetable or salad to balance this out nutritionally. (I picked broccoli as an example) If you can afford the calories, add a desert. (Ice cream in this case)  Then decide what night in your schedule this will work best.  This recipe will take about 12 minutes total so it would be great for a night you are getting home late.  You can either share the other portion with your significant other or you can take it with you the next day as lunch.  You can double the recipe and have it more than one night.   For example:

	Breakfast	Lunch	Snack	Dinner	Comments
Sun
Mon					On call – take Tues meals, too
Tues
Wed				Out	Out with friends after roundsThaw shrimp for tomorrow
Thur				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoliIce Cream	Freeze one portion for later
Fri				NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli	On call
Sat		NEW NEW ORLEANS PASTA (CHICKEN, CHORIZO)Steamed broccoli

Shopping list:

2 lbs chicken breast (16 oz x 2)

1/2 cup chopped chorizo sausage

1/2 pound shrimp, peeled and deveined

heavy cream   (need 1 1/5  cup)

Parmesan cheese  (need 1/2 cup grated)

Olive oil

Creole spice

green onions

garlic

broccoli (4 portions to steam)

One pound penne pasta

Ice cream

Rule 3:  Cook (or prep) today today to eat tomorrow

As soon as you get home from the grocery store:

• Freeze any meat that is for later in the week (and make a note to yourself to put in into the refrigerator to thaw a day or two before you are going to use it.)
• Wash the vegetables, dry them and put them away
• Wash lettuce for salads and dry completely (a spin dryer is the best).  Store in a zip lock plastic bag with a paper towel in the bag (which absorbs any residual water).  Make sure you squeeze out all the air you can before closing the bag.

Take advantage of days off to cook things that may take a little more time or effort.  While  you are watch the football game on Sunday, you can cook chili in a crock pot for Wednesday.  If you know that your vegetable stir fry on Tuesday is going to be after a long day, go ahead and chop all the vegetables and meat a day or two before when you have the time and have them stored in the refrigerator.   When Tuesday rolls around (and you are exhausted from work), you’ll have all the ingredients chopped and ready to throw in the pan.